Li Sijian, Gao Jinsong, Liu Juntao, Hu Jing, Chen Xiaoxu, He Jing, Tang Yabing, Liu Xinghui, Cao Yinli, Liu Xiaowei, Wang Xietong
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China.
Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, China.
Front Med (Lausanne). 2021 Aug 23;8:673500. doi: 10.3389/fmed.2021.673500. eCollection 2021.
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women. A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted. A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813-0.851), 0.824 (95% CI 0.803-0.845), 0.686 (95% CI 0.617-0.755), 0.854 (95% CI 0.834-0.874), and 0.690 (95% CI 0.646-0.735), respectively. The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.
产后出血（PPH）是全球孕产妇发病和死亡的主要原因，但中国的发病率及其危险因素的相关研究有限。本研究的目的是调查中国女性产后出血的发病率及其危险因素。对孕周≥28周的孕妇进行了一项多中心回顾性研究。采用逻辑回归确定产后出血的潜在危险因素，并使用受试者工作特征曲线评估所确定危险因素的预测性能。针对胎儿数量和分娩方式进行了亚组分析。共纳入99253名孕妇，其中804名（0.81%）发生了产后出血。亚组分析显示，单胎、双胎妊娠、剖宫产和阴道分娩的产后出血发生率分别为0.75%、2.65%、1.40%和0.31%。前置胎盘和胎盘植入是总体人群及所有亚组中产后出血的主要危险因素。无论分娩方式如何，双胎妊娠都是产后出血的危险因素。肥胖和多产是单胎妊娠和剖宫产病例中产后出血的危险因素，但在阴道分娩中，多产预示产后出血的概率降低。巨大儿与单胎妊娠或阴道分娩中产后出血风险增加相关。在阴道分娩的女性中，子痫前期与产后出血风险较高相关。总体队列、单胎妊娠、双胎妊娠、剖宫产病例和阴道分娩的曲线下面积分别为0.832（95%置信区间[CI]0.813 - 0.851）、0.824（95%CI 0.803 - 0.845）、0.686（95%CI 0.617 - 0.755）、0.854（95%CI 0.834 - 0.874）和0.690（95%CI 0.646 - 0.735）。产后出血的危险因素因胎儿数量和分娩方式略有不同，而前置胎盘和胎盘植入是两个主要危险因素。所确定的危险因素组合在确定总体队列、单胎妊娠和剖宫产分娩女性的产后出血方面具有令人满意的预测性能，而在双胎妊娠和阴道分娩女性中性能中等。
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