Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
Rev Bras Ginecol Obstet. 2021 Feb;43(2):113-118. doi: 10.1055/s-0040-1718439. Epub 2021 Jan 28.
To identify risk factors related to postpartum hemorrhage (PPH) and severe PPH with blood loss quantified objectively.
This is a complementary analysis of a prospective cohort study that included pregnant women delivering vaginally. The total blood loss was obtained through the sum of the volume collected from the drape with the weight of gauzes, compresses and pads used by women within 2 hours. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. The risk factors for postpartum bleeding were evaluated using linear and logistic regression.
We included 270 women. The mean blood loss at 120 minutes was 427.49 mL (±335.57 mL). Thirty-one percent (84 women) bled > 500 mL and 8.2% (22 women) bled > 1,000 mL within 2 hours. Episiotomy, longer second stage of labor and forceps delivery were related to blood loss > 500 mL within 2 hours, in the univariate analysis. In the multivariate analysis, only forceps remained associated with bleeding > 500 mL within 2 hours (odds ratio [OR] = 9.5 [2.85-31.53]). Previous anemia and episiotomy were also related to blood loss > 1,000mL.
Prolonged second stage of labor, forceps and episiotomy are related to increased incidence of PPH, and should be used as an alert for the delivery assistants for early recognition and prompt treatment for PPH.
确定与产后出血（PPH）和出血量客观量化的重度 PPH 相关的风险因素。
这是一项前瞻性队列研究的补充分析，纳入了阴道分娩的孕妇。总出血量通过收集产妇在 2 小时内使用的围裙、纱布、压布和垫的重量之和来获得。进行探索性数据分析以评估平均值、标准差（SD）、频率、百分比和百分位数。使用线性和逻辑回归评估产后出血的风险因素。
我们纳入了 270 名妇女。120 分钟时的平均出血量为 427.49 毫升（±335.57 毫升）。31%（84 名妇女）在 2 小时内出血量>500 毫升，8.2%（22 名妇女）出血量>1000 毫升。在单因素分析中，会阴切开术、第二产程延长和产钳分娩与 2 小时内出血量>500 毫升相关。在多因素分析中，只有产钳与 2 小时内出血量>500 毫升相关（比值比[OR] = 9.5[2.85-31.53]）。既往贫血和会阴切开术也与出血量>1000 毫升相关。
第二产程延长、产钳和会阴切开术与 PPH 发生率增加相关，应作为分娩助手的警示，以便早期识别和及时治疗 PPH。
