Parpex Guillaume, Khediri Zied, Michel Philippe, Visbecq Jean-Noël, Duviquet Marie-José, Poncelet Christophe
Department of Obstetrics and Gynaecology, René Dubos Hospital, Cergy-Pontoise, France.
Department of Obstetrics and Gynaecology, René Dubos Hospital, Cergy-Pontoise, France.
Eur J Obstet Gynecol Reprod Biol. 2021 Mar;258:299-303. doi: 10.1016/j.ejogrb.2021.01.019. Epub 2021 Jan 19.
A sudden postpartum hemorrhage (PPH) increase has been subjectively observed during summer 2018 in our level-3 maternity, despite following all official recommendations for PPH care. This observation led us to conduct a morbi-mortality review to understand morbidity increase reasons.
We conducted a first retrospective comparative cohort study from 2017 to 2018 to compare PPH rates. We conducted a second comparative study to determine the factors that may have led to an increase in PPH. One of the initial hypotheses of increased PPH was related to the weakness of oxytocin, exposed to high outside temperatures. The eight-day delivery records were analyzed, as follow: the high-frequency period of PPH (EXPOSED), the batch replacement of oxytocin (NON EXPOSED), and the same period of the previous year (1 YEAR BEFORE). We studied all known PPH risk factors: preconception, pregnancy, childbirth, and human, climatic, or material organizational factors in this maternity.
322 women were included: 111, 92, and 119 in the EXPOSED, NON EXPOSED, and 1 YEAR BEFORE groups, respectively. Sociodemographic data of the 3 groups were not different. The rate of PPH in the EXPOSED was significantly higher than that of NON EXPOSED, and 1 YEAR BEFORE: 20.7 %, 7.6 %, and 5.8 %, respectively (p = 0.0077). In the multivariate analysis, the reduction in PPH (EXPOSED vs NON EXPOSED) after changing the oxytocin batch was significant (OR 0.38 [0.14-0.91], p = 0.039).
Changing oxytocin batches during this hot period reduced significantly the PPH rate and maternal morbidity in our experience.
2018年夏季，在我们的三级妇产医院中，尽管遵循了所有关于产后出血（PPH）护理的官方建议，但主观上观察到产后出血突然增加。这一观察结果促使我们进行了一次死亡病例讨论，以了解发病率增加的原因。
我们进行了第一项回顾性比较队列研究，比较2017年至2018年的产后出血率。我们进行了第二项比较研究，以确定可能导致产后出血增加的因素。产后出血增加的最初假设之一与暴露于高温环境下的催产素效力减弱有关。对八天的分娩记录进行了如下分析：产后出血的高频期（暴露组）、催产素批量更换期（非暴露组）以及上一年同期（前一年）。我们研究了该妇产医院所有已知的产后出血危险因素：孕前、孕期、分娩以及人为、气候或物质组织因素。
共纳入322名女性，暴露组、非暴露组和前一年组分别为111名、92名和119名。三组的社会人口统计学数据无差异。暴露组的产后出血率显著高于非暴露组和前一年组，分别为20.7%、7.6%和5.8%（p = 0.0077）。在多变量分析中，更换催产素批次后产后出血率的降低（暴露组与非暴露组相比）具有显著性（比值比0.38 [0.14 - 0.91]，p = 0.039）。
在这段炎热时期更换催产素批次，根据我们的经验，显著降低了产后出血率和孕产妇发病率。
