Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Matern Fetal Neonatal Med. 2022 Sep;35(18):3626-3630. doi: 10.1080/14767058.2020.1834533. Epub 2021 Jan 28.
To identify risk factors for postpartum hemorrhage (PPH) following cesarean delivery (CD).
A retrospective study of all women who underwent CD in a university-affiliated tertiary hospital (2014-15). PPH was defined as any of the following: clinical PPH (≥1000 ml estimated blood loss), hemoglobin (Hb) drop ≥3 g/dl (the difference between pre-CD Hb level within a 24 h prior to the delivery) and post-CD (nadir level during the first 72 h after CD)) or the need for blood products transfusion. The characteristics of women with PPH following CD were compared to a control group of those with CD without PPH.
Of the 15,564 deliveries during the study period, 3208 (20.6%) women met inclusion criteria, of them, 307 (9.6%) had PPH and 2901 (90.4%) served as controls. Women in the PPH group were younger (32.6 ± 5.3 33.5 ± 5.4, = .006) and more often nulliparous (45.9% 33.3%, <.001) compared to the controls. However, there were no differences between the groups regarding the rate of multiple gestations, maternal diabetes mellitus, hypertensive disorders, polyhydramnios, and macrosomia. The rates of induction of labor (16.3% 8.6%, <.001) and urgent CD (47.9% 32.0%, <.001) were higher in the PPH group compared to the controls. In multivariate logistic regression, predictors for PPH following CD were (odds ratio, 95% confidence interval) urgent CS (1.57, 1.78-2.11, = .002), CD duration (1.02, 1.01-1.03, <.001), and the number of previous CDs (0.74, 0.62-0.90, = .003).
In women undergoing cesarean section, urgent CD, the duration of the surgery, and the number of the previous CD are associated with the risk of PPH and should be taken into consideration during the postpartum assessment.
确定剖宫产产后出血（PPH）的风险因素。
这是一项对在大学附属三级医院进行剖宫产的所有女性（2014-15 年）进行的回顾性研究。PPH 被定义为以下任何一种情况：临床 PPH（≥1000ml 估计失血量）、血红蛋白（Hb）下降≥3g/dl（分娩前 24 小时内 CD 前 Hb 水平的差异）和 CD 后（CD 后 72 小时内的最低水平）或需要输血。将发生 PPH 的 CD 女性的特征与无 PPH 的 CD 对照组进行比较。
在研究期间的 15564 次分娩中，符合纳入标准的 3208 名女性中，有 307 名（9.6%）发生了 PPH，2901 名（90.4%）作为对照组。PPH 组的女性更年轻（32.6±5.3 vs. 33.5±5.4，=0.006），且更多为初产妇（45.9% vs. 33.3%，<0.001）。然而，两组之间的多胎妊娠率、母体糖尿病、高血压疾病、羊水过多和巨大儿率没有差异。与对照组相比，诱导分娩率（16.3% vs. 8.6%，<0.001）和紧急剖宫产率（47.9% vs. 32.0%，<0.001）更高。在多变量逻辑回归中，预测 PPH 的因素为紧急 CS（比值比，95%置信区间）1.57（1.78-2.11，=0.002）、CD 持续时间（1.02，1.01-1.03，<0.001）和先前 CD 数量（0.74，0.62-0.90，=0.003）。
在接受剖宫产的女性中，紧急剖宫产、手术持续时间和先前 CD 的数量与 PPH 的风险相关，应在产后评估中考虑到这些因素。
