GENESIS Research, West One, Forth Banks, Newcastle Upon Tyne, United Kingdom.
GENESIS Research, West One, Forth Banks, Newcastle Upon Tyne, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2022 Jan;268:92-99. doi: 10.1016/j.ejogrb.2021.11.432. Epub 2021 Nov 28.
Postpartum haemorrhage (PPH) complicates approximately 5% of births worldwide and is a leading direct cause of maternal death. Rates of PPH are increasing in many developed countries, particularly PPH related to uterine atony. There is a lack of published up-to-date information about healthcare resource use associated with management of PPH following vaginal birth. The objective of this study was to describe healthcare resource use for the management of minor PPH (blood loss 500-1,000 ml) and major PPH (blood loss > 1,000 ml) compared to uncomplicated birth (no PPH) following hospital vaginal birth in France, Italy, the Netherlands, and the UK.
In-depth interviews with two midwives from each participating country were conducted to establish differences in resource use for the management of minor PPH, major PPH, and uncomplicated birth. A web-survey was then developed and one obstetrician per participating country reviewed the survey. In total, 100 midwives (25 per country) completed the survey. Results were discussed at a multi-professional consensus meeting of midwives and obstetricians/gynaecologists (n = 6).
Midwives participating in the survey estimated that 80% of women receive Active Management of the Third Stage of Labour (AMTSL) and 93% of participants specified that uterotonics would routinely be used during AMTSL. Most participants (84%) reported that blood loss is routinely measured in their hospital, using a combination of methods. PPH is associated with increased healthcare resource use, including administration of additional uterotonics and use of additional medical interventions, such as urinary catheter, intravenous fluids, and possible requirement for surgery. The number of nurses, obstetricians/gynaecologists, and anaesthetists involved in the management of PPH increases with the occurrence and severity of PPH, as well as the proportion of healthcare personnel providing continuous care. Women may spend an additional 24 h in hospital following major PPH compared to uncomplicated birth. The results of this study highlight the burden of PPH management on healthcare resources. To reduce costs associated with PPH, prevention is the most effective strategy and can be enhanced with the use of an effective uterotonic as part of the active management of the third stage of labour.
产后出血（PPH）在全球约占分娩的 5%，是产妇死亡的主要直接原因。在许多发达国家，PPH 的发生率正在上升，特别是与子宫收缩乏力相关的 PPH。目前缺乏关于与阴道分娩后 PPH 管理相关的医疗资源使用的最新信息。本研究的目的是描述法国、意大利、荷兰和英国的医院阴道分娩后，与轻微 PPH（出血量 500-1000ml）和严重 PPH（出血量>1000ml）相比，管理轻微 PPH 和严重 PPH 所涉及的医疗资源使用情况。
对每个参与国家的两名助产士进行深入访谈，以确定管理轻微 PPH、严重 PPH 和无 PPH 分娩的资源使用差异。然后开发了一个网络调查，每个参与国家的一名产科医生审查了该调查。共有 100 名助产士（每个国家 25 名）完成了调查。结果在助产士和妇产科医生/妇科医生的多专业共识会议上进行了讨论（n=6）。
参与调查的助产士估计，80%的妇女接受第三产程主动管理（AMTSL），93%的参与者表示在 AMTSL 期间常规使用宫缩剂。大多数参与者（84%）报告说，他们的医院会常规测量出血量，使用多种方法。PPH 会导致医疗资源使用增加，包括额外使用宫缩剂和额外的医疗干预，如导尿管、静脉输液以及可能需要手术。参与 PPH 管理的护士、妇产科医生和麻醉师的数量随着 PPH 的发生和严重程度以及提供连续护理的医护人员比例的增加而增加。与无 PPH 分娩相比，严重 PPH 后妇女可能会在医院多呆 24 小时。本研究的结果强调了 PPH 管理对医疗资源的负担。为了降低与 PPH 相关的成本，预防是最有效的策略，通过在第三产程主动管理中使用有效的宫缩剂，可以增强预防效果。
