Thams Amalie Birkmose, Larsen Marie Høygaard, Rasmussen Steen Christian, Jeppegaard Maria, Krebs Lone
Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Arch Gynecol Obstet. 2023 Apr;307(4):1217-1224. doi: 10.1007/s00404-022-06591-4. Epub 2022 May 20.
To assess incidence and risk factors for postpartum hemorrhage (PPH) and identify women at high risk of recurrence in the subsequent pregnancy.
This register-based study includes data on women from the Capital Region of Denmark with two consecutive deliveries recorded in the Copenhagen Obstetric Database from 2007 to 2020. PPH, defined as a blood loss of 1000 mL or more within 24 h after delivery, was the primary outcome measure. We calculated incidence and recurrence rate of PPH and assessed possible risk factors at index and subsequent deliveries.
We included 44,800 women with 95,673 deliveries. The overall incidence of PPH was 6.3%. Women with previous PPH had a 3.5-fold increased risk of PPH in a subsequent delivery compared to unaffected women (19.1 vs. 5.4%; OR 4.1; 95% CI 3.7-4.5). Major risk factors for recurrence were PPH in combination with blood transfusion or manual removal of placenta at the index delivery. Labor induction in subsequent pregnancy increased the risk of recurrent PPH compared to spontaneous onset (OR 1.5; 95% CI 1.2-1.9), while planned caesarean section reduced the risk, compared to planned vaginal delivery (OR 0.6; 95% CI 0.4-0.7).
Previous PPH increases the risk of PPH in subsequent pregnancy 3.5-fold. The risk of recurrent PPH increases with labor induction and decreases with planned caesarean section in the subsequent pregnancy. To prevent recurrent PPH, personalized counseling based on risk factors, relevant labor history and maternal preferences is suggested.
评估产后出血（PPH）的发生率及危险因素，并识别后续妊娠中有复发高风险的女性。
这项基于登记册的研究纳入了丹麦首都地区女性的数据，这些女性在2007年至2020年期间在哥本哈根产科数据库中有连续两次分娩记录。PPH定义为分娩后24小时内失血1000毫升或更多，是主要结局指标。我们计算了PPH的发生率和复发率，并评估了首次及后续分娩时可能的危险因素。
我们纳入了44,800名女性的95,673次分娩。PPH的总体发生率为6.3%。与未受影响的女性相比，既往有PPH的女性在后续分娩中发生PPH的风险增加3.5倍（19.1%对5.4%；OR 4.1；95%CI 3.7 - 4.5）。复发的主要危险因素是首次分娩时PPH合并输血或人工剥离胎盘。与自然发动分娩相比，后续妊娠引产增加了复发性PPH的风险（OR 1.5；95%CI 1.2 - 1.9），而与计划阴道分娩相比，计划剖宫产降低了风险（OR 0.6；95%CI 0.4 - 0.7）。
既往PPH使后续妊娠中发生PPH的风险增加3.5倍。后续妊娠中，复发性PPH的风险随引产增加而升高，随计划剖宫产降低。为预防复发性PPH，建议根据危险因素、相关分娩史和产妇偏好进行个性化咨询。
