Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
PLoS One. 2022 Oct 14;17(10):e0275879. doi: 10.1371/journal.pone.0275879. eCollection 2022.
To explore risk profiles of the different types of postpartum hemorrhage (PPH >500ml or severe PPH >1500ml) and their recurrence risks in a subsequent delivery.
With data from The Medical Birth Registry of Norway and Statistics Norway we performed a population-based cohort study including all singleton deliveries in Norway from 1967-2017. Multilevel logistic regression was used to calculate odds ratio (OR), with 95% confidence interval (CI), with different PPH types (PPH >500ml or PPH >1500ml (severe PPH) combined with retained placenta, uterine atony, obstetric trauma, dystocia, or undefined cause) as outcomes.
We identified 277 746 PPH cases of a total of 3 003 025 births (9.3%) from 1967 to 2017. Retained placenta (and/or membranes) was most often registered as severe PPH (29.3%). Maternal, fetal, and obstetric characteristics showed different associations with the PPH types. Male sex of the neonate was associated with reduced risk of PPH. This effect was strongest on PPH due to retained placenta (adjusted OR, (aOR): 0.80, 95% CI 0.78-0.82), atony (aOR 0.92, 95% CI: 0.90-0.93) and PPH with undefined cause (aOR 0.96, 95% CI: 0.95-0.97). Previous cesarean section showed a strong association with PPH due to dystocia (aOR of 13.2, 95% CI: 12.5-13.9). Recurrence risks were highest for the same type: PPH associated with dystocia (aOR: 6.8, 95% CI: 6.3-7.4), retained placenta and/or membranes (aOR: 5.9, 95% CI: 5.5-6.4), atony (aOR: 4.0, 95% CI: 3.8-4.2), obstetric trauma (aOR: 3.9, 95% CI: 3.5-4.3) and PPH of undefined cause (aOR: 2.2, 95% CI: 2.1-2.3).
Maternal, fetal and obstetric characteristics had differential effects on types of PPH. Recurrence differed considerably between PPH types. Retained placenta was most frequently registered with severe PPH, and showed strongest effect of sex; delivery of a boy was associated with lower risk of PPH. Previous cesarean increased the risk of PPH due to dystocia.
探讨不同类型产后出血（PPH >500ml 或严重产后出血 PPH >1500ml）的风险特征及其在后续分娩中的复发风险。
利用挪威医学出生登记处和挪威统计局的数据，我们进行了一项基于人群的队列研究，纳入了 1967 年至 2017 年期间挪威所有的单胎分娩。采用多水平逻辑回归计算比值比（OR）及其 95%置信区间（CI），以不同类型的产后出血（PPH >500ml 或 PPH >1500ml（严重产后出血）合并胎盘滞留、子宫收缩乏力、产科创伤、产程延长或原因不明）为结局。
我们从 1967 年至 2017 年共识别出 3003025 例分娩中 277746 例 PPH（9.3%）。胎盘滞留（和/或胎膜）最常被记录为严重产后出血（29.3%）。母婴和产科特征与不同类型的产后出血有不同的关联。新生儿为男性与 PPH 风险降低相关。这种影响在因胎盘滞留导致的 PPH 中最为明显（校正 OR，aOR：0.80，95%CI：0.78-0.82）、宫缩乏力（aOR：0.92，95%CI：0.90-0.93）和原因不明的 PPH（aOR：0.96，95%CI：0.95-0.97）。既往剖宫产与因产程延长导致的 PPH 有很强的关联（aOR 为 13.2，95%CI：12.5-13.9）。复发风险以相同类型最高：与产程延长相关的 PPH（aOR：6.8，95%CI：6.3-7.4）、胎盘滞留和/或胎膜（aOR：5.9，95%CI：5.5-6.4）、宫缩乏力（aOR：4.0，95%CI：3.8-4.2）、产科创伤（aOR：3.9，95%CI：3.5-4.3）和原因不明的 PPH（aOR：2.2，95%CI：2.1-2.3）。
母婴和产科特征对不同类型的产后出血有不同的影响。不同类型的产后出血复发风险差异较大。胎盘滞留最常与严重产后出血一起记录，且性别影响最大；分娩男孩与较低的 PPH 风险相关。既往剖宫产增加了因产程延长导致的 PPH 风险。
