Januszewski Marcin, Santor-Zaczyńska Małgorzata, Ziuzia-Januszewska Laura, Kudan Michał, Jakimiuk Alicja A, Wierzba Waldemar, Jakimiuk Artur J
Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland.
Department of Otolaryngology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland.
Biomedicines. 2022 Oct 9;10(10):2517. doi: 10.3390/biomedicines10102517.
The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Poland. From 15 May 2020 to 26 April 2021, a total of 224 parturients with COVID-19 infection were admitted for labor. The control group consisted of 300 randomly recruited pre-pandemic deliveries that took place between 15 May 2019 and 26 April 2020 at the Department. The primary outcome was the presence of postpartum hemorrhage, defined as an estimated blood loss of ≥500 mL within 24 h after birth or the need to transfuse 2 or more units of packed red blood cells (pRBCs). Secondary outcomes were the difference between hemoglobin and hematocrit levels at 24 h postpartum, the number of pRBCs units transfused, and the need for transperitoneal drainage. After applying the propensity-score-matching procedure for postpartum bleeding risk factors, 325 eligible patients were included in the final analysis, divided into 203 COVID-19 positive and 122 COVID-19 negative prepandemic deliveries. SARS-CoV-2 infected patients were characterized by a longer activated partial thromboplastin time (APTT), a reduced prothrombin time (PT), and lower platelet count at initial presentation. COVID-19 deliveries were found to be associated with a higher frequency of postpartum hemorrhage, an increased estimated blood loss, the more frequent use of peritoneal drainage, and more pRBCs units transfused. During the pandemic, an increased risk of postpartum hemorrhage posed another threat to SARS-CoV-2 infected pregnant women. It is essential to be aware of this when approaching COVID-19 delivery and to implement efficient preventative methods.
本研究的目的是比较感染和未感染新冠病毒的孕妇之间的估计失血量及产科出血频率。该研究在波兰华沙内政与行政部中央临床医院的妇产科开展。2020年5月15日至2021年4月26日，共有224例感染新冠病毒的产妇入院分娩。对照组由2019年5月15日至2020年4月26日期间在该科室随机选取的300例疫情前分娩病例组成。主要结局是产后出血的发生情况，产后出血定义为出生后24小时内估计失血量≥500 mL或需要输注2个或更多单位的浓缩红细胞（pRBCs）。次要结局包括产后24小时血红蛋白和血细胞比容水平的差异、输注的pRBCs单位数量以及是否需要经皮引流。在对产后出血危险因素应用倾向评分匹配程序后，最终分析纳入了325例符合条件的患者，分为203例新冠病毒阳性和122例新冠病毒阴性的疫情前分娩病例。感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的患者在初次就诊时的活化部分凝血活酶时间（APTT）较长、凝血酶原时间（PT）缩短且血小板计数较低。发现新冠病毒感染产妇产后出血频率较高、估计失血量增加、更频繁使用腹膜引流且输注的pRBCs单位更多。在疫情期间，产后出血风险增加对感染SARS-CoV-2的孕妇构成了另一个威胁。在处理新冠病毒感染产妇分娩时必须意识到这一点，并实施有效的预防措施。
