Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Baton Rouge, LA, USA.
Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):7353-7359. doi: 10.1080/14767058.2021.1948528. Epub 2021 Jul 25.
Postpartum hemorrhage (PPH) is the most common cause of maternal mortality worldwide. Predicting PPH remains difficult, and risk factors vary among populations. We aimed to determine prevalence, risk factors, and causes for PPH in our obstetric population in South-Central Louisiana.
We conducted a retrospective cohort study utilizing medical records for deliveries between October 2015 and September 2020 at Woman's Hospital, a tertiary hospital in South-Central Louisiana. PPH was defined by the current American College of Obstetricians and Gynecologists' (ACOG) criteria as cumulative blood loss greater than or equal to 1000 mL within 24 h after the birth process regardless of route of delivery. Logistic regression assessed the association of PPH and possible risk factors: anemia at the time of delivery, race, parity, delivery mode, body mass index, age, and health insurance. An additional logistic regression also investigated risk factors within our cohort for severe maternal morbidity among patients who experienced PPH including the same covariates.
A total of 30,674 deliveries were included in our cohort, among which PPH occurred in 12.3% ( = 3773). Patients experiencing PPH were more likely to be of Black race, Medicaid-eligible, deliver cesarean section, and have lower hemoglobin and hematocrit at time of delivery compared to patients without PPH (all < .001). Anemia at delivery (aOR = 1.28; 95%CI = 1.154-1.419), cesarean delivery (aOR = 8.796; 95%CI = 7.731-10.007), BMI > 40kg/m (aOR = 1.363; 95%CI = 1.186-1.567), and Black race (aOR = 1.233; 95%CI = 1.099-1.383) were the strongest predictors of PPH. Among cesarean cases ( = 10,888), Black race and BMI > 40 kg/m were the strongest predictors for PPH. Among patients who experienced PPH, anemia was associated with a higher likelihood of experiencing a severe maternal morbidity event (aOR = 2.587; 95%CI = 1.990-3.364).
Consistent with literature in the United States, Black race, increased BMI, cesarean delivery, and anemia were associated with risk of PPH. Anemia at delivery increased the risk for severe maternal morbidity among patients experiencing PPH.
产后出血（PPH）是全球范围内导致产妇死亡的最常见原因。预测 PPH 仍然具有挑战性，且风险因素在不同人群中存在差异。我们旨在确定我们在路易斯安那州中南部的产科人群中 PPH 的流行率、风险因素和原因。
我们进行了一项回顾性队列研究，利用 2015 年 10 月至 2020 年 9 月期间 Woman's Hospital 的分娩病历，该医院是路易斯安那州中南部的一家三级医院。PPH 按照当前美国妇产科医师学会（ACOG）的标准定义为产后 24 小时内出血量超过 1000ml，无论分娩方式如何。逻辑回归评估了 PPH 与可能的风险因素之间的关联：分娩时贫血、种族、产次、分娩方式、体重指数、年龄和医疗保险。另外的逻辑回归还调查了我们队列中 PPH 患者中严重产妇发病率的风险因素，包括相同的协变量。
共有 30674 例分娩纳入我们的队列，其中 12.3%（n=3773）发生了 PPH。与未发生 PPH 的患者相比，发生 PPH 的患者更有可能为黑人、符合医疗补助条件、行剖宫产术，且分娩时血红蛋白和血细胞比容较低（均<.001）。分娩时贫血（aOR=1.28；95%CI=1.154-1.419）、剖宫产（aOR=8.796；95%CI=7.731-10.007）、BMI＞40kg/m（aOR=1.363；95%CI=1.186-1.567）和黑种人（aOR=1.233；95%CI=1.099-1.383）是 PPH 的最强预测因素。在剖宫产病例中（n=10888），黑种人和 BMI＞40kg/m 是 PPH 的最强预测因素。在发生 PPH 的患者中，贫血与严重产妇发病率事件的发生可能性增加相关（aOR=2.587；95%CI=1.990-3.364）。
与美国文献一致，黑种人、BMI 增加、剖宫产和贫血与 PPH 的风险相关。分娩时贫血增加了发生 PPH 的患者发生严重产妇发病率的风险。
