Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois.
Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois.
Am J Perinatol. 2024 Jun;41(8):1050-1054. doi: 10.1055/a-1786-9096. Epub 2022 Mar 3.
The objective of the study was to evaluate whether patients with oxytocin discontinued during the second stage of labor (≥30 minutes prior to delivery) had a lower rate of postpartum hemorrhage (PPH) compared with those with oxytocin continued until delivery or discontinued <30 minutes prior to delivery.
Retrospective cohort study was performed from August 1, 2014 to July 31, 2019. Singleton pregnancies of 24 to 42 weeks gestation were included if they reached the second stage of labor and received oxytocin during labor. Patients on anticoagulants were excluded. Patients with oxytocin discontinued ≥30 minutes prior to delivery represented STOPPED and those with oxytocin continued until delivery or discontinued <30 minutes prior to delivery represented CONTINUED. Patient data were abstracted from the electronic medical record. The primary outcome was PPH (≥1,000 mL blood loss). Univariable analyses were performed to compare groups. Multi-variable logistic regression was performed to adjust for prespecified confounders. Planned sub-group analyses by the route of delivery were performed.
Of 10,421 total patients, 1,288 had oxytocin STOPPED and 9,133 had oxytocin CONTINUED. There were no significant differences in age, race, or ethnicity, body mass index, public insurance, gestational diabetes, or pregnancy-induced hypertension between STOPPED and CONTINUED. The PPH rate was 15.2 and 5.7% in STOPPED and CONTINUED, respectively ( < 0.001). After adjusting for confounders, STOPPED remained at higher odds for PPH (adjusted odds ratio 2.859, 95% confidence interval 2.394, 3.414, < 0.001). Among cesarean deliveries only, there was no significant difference in the rate of PPH between STOPPED and CONTINUED (38.0 vs. 36.4%, respectively, = 0.730). However, among vaginal deliveries, the rate of PPH was actually lower in STOPPED than CONTINUED (3.4 vs. 5.2%, respectively, = 0.024).
The rate of PPH was higher in patients with oxytocin STOPPED compared with CONTINUED. However, among vaginal deliveries, there was a significantly lower rate of PPH in STOPPED. These disparate findings may be explained by the variable impact of second-stage oxytocin on PPH as a function of delivery type.
· It is unclear if oxytocin use in the second stage of labor may independently increase the risk of hemorrhage.. · Patients with oxytocin discontinued during the second stage of labor had a higher rate of PPH.. · PPH was significantly lower among vaginal deliveries in patients with oxytocin discontinued..
本研究旨在评估在第二产程中停止（分娩前≥30 分钟）催产素与持续使用催产素直至分娩或在分娩前<30 分钟停止催产素的患者相比，产后出血（PPH）的发生率是否更低。
这是一项回顾性队列研究，于 2014 年 8 月 1 日至 2019 年 7 月 31 日进行。纳入 24 至 42 周妊娠、进入第二产程并在分娩期间接受催产素的单胎妊娠患者。排除使用抗凝剂的患者。在分娩前≥30 分钟停止使用催产素的患者代表 STOPPED 组，而在分娩前持续使用或<30 分钟停止使用催产素的患者代表 CONTINUED 组。从电子病历中提取患者数据。主要结局为 PPH（≥1000ml 失血量）。采用单变量分析比较组间差异。采用多变量逻辑回归调整预设混杂因素。按分娩方式进行了计划的亚组分析。
在 10421 例患者中，1288 例患者停止使用催产素，9133 例患者持续使用催产素。STOPPED 组和 CONTINUED 组在年龄、种族或民族、体重指数、公共保险、妊娠期糖尿病或妊娠高血压之间无显著差异。STOPPED 组和 CONTINUED 组的 PPH 发生率分别为 15.2%和 5.7%（<0.001）。调整混杂因素后，STOPPED 组发生 PPH 的可能性仍更高（调整优势比 2.859，95%置信区间 2.394 至 3.414，<0.001）。仅在剖宫产中，STOPPED 组和 CONTINUED 组的 PPH 发生率无显著差异（分别为 38.0%和 36.4%，=0.730）。然而，在阴道分娩中，STOPPED 组的 PPH 发生率实际上低于 CONTINUED 组（分别为 3.4%和 5.2%，=0.024）。
与持续使用催产素的患者相比，停止使用催产素的患者 PPH 发生率更高。然而，在阴道分娩中，STOPPED 组的 PPH 发生率明显更低。这些不同的发现可能是由于第二产程中催产素对 PPH 的影响因分娩方式而异。
· 在第二产程中使用催产素是否会独立增加出血风险尚不清楚。· 在第二产程中停止使用催产素的患者 PPH 发生率更高。· 在停止使用催产素的阴道分娩患者中，PPH 的发生率显著降低。
