Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India.
Women's and Children's Health Research Unit JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.
Reprod Health. 2021 Nov 14;18(1):230. doi: 10.1186/s12978-021-01284-8.
Obstetric haemorrhage continues to be a leading cause of maternal mortality, contributing to more than a quarter of the 2,443,000 maternal deaths reported between 2003 and 2009. During this period, about 70% of the haemorrhagic deaths occurred postpartum. In addition to other identifiable risk factors for greater postpartum blood loss, the duration of the third stage of labour (TSL) seems to be important, as literature shows that a longer TSL can be associated with more blood loss. To better describe the association between the duration of TSL and postpartum blood loss in women receiving active management of third stage of labour (AMTSL), this secondary analysis of the WHO CHAMPION trial data has been conducted.
This was a secondary analysis of the WHO CHAMPION trial conducted in twenty-three sites in ten countries. We studied the association between the TSL duration and blood loss in the sub cohort of women from the CHAMPION trial (all of whom received AMTSL), with TSL upto 60 min and no interventions for postpartum haemorrhage. We used a general linear model to fit blood loss as a function of TSL duration on the log scale, arm and center, using a normal distribution and the log link function. We showed this association separately for oxytocin and for Heat stable (HS) carbetocin.
For the 10,040 women analysed, blood loss rose steeply with third stage duration in the first 10 min, but more slowly after 10 min. This trend was observed for both Oxytocin and HS carbetocin and the difference in the trends for both drugs was not statistically significant (p-value = 0.2070).
There was a positive association between postpartum blood loss and TSL duration with either uterotonic. Blood loss rose steeply with TSL duration until 10 min, and more slowly after 10 min. Study registration The main trial was registered with Australian New Zealand Clinical Trials Registry ACTRN12614000870651 and Clinical Trial Registry of India CTRI/2016/05/006969.
产科出血仍然是产妇死亡的主要原因，占 2003 年至 2009 年报告的 244.3 万例产妇死亡的四分之一以上。在此期间，约 70%的出血性死亡发生在产后。除了其他可识别的产后出血量增加的危险因素外，第三产程（第三产程）的持续时间似乎很重要，因为文献表明，第三产程较长与更多的失血有关。为了更好地描述接受第三产程主动管理（AMTSL）的妇女第三产程持续时间与产后出血之间的关系，对世界卫生组织 CHAMPION 试验数据进行了二次分析。
这是在十个国家的二十三个地点进行的世界卫生组织 CHAMPION 试验的二次分析。我们研究了在 CHAMPION 试验的亚队列（所有妇女均接受 AMTSL）中第三产程持续时间与失血量之间的关系，第三产程持续时间长达 60 分钟，且无产后出血干预措施。我们使用一般线性模型，在对数尺度上拟合血容量作为第三产程持续时间的函数，使用正态分布和对数链接函数。我们分别显示了催产素和热稳定（HS）卡贝缩宫素的这种关联。
对于分析的 10040 名妇女，产后出血量在前 10 分钟内随着第三产程持续时间的增加而急剧上升，但在 10 分钟后上升速度较慢。这种趋势在催产素和 HS 卡贝缩宫素中均观察到，两种药物的趋势差异无统计学意义（p 值=0.2070）。
无论是使用哪种子宫收缩剂，产后出血与第三产程持续时间之间都存在正相关关系。产后出血量随第三产程持续时间的增加而急剧上升，直到 10 分钟，之后上升速度较慢。试验注册主要试验在澳大利亚新西兰临床试验注册处 ACTRN12614000870651 和印度临床试验注册处 CTRI/2016/05/006969 注册。
