根据出生体重总和评估双胎妊娠发生严重产后出血的风险。
Risk of Severe Postpartum Hemorrhage in Twin Pregnancies According to the Sum of Birth Weights.
机构信息
Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team - INSERM U1153, the Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, the Clinical Research Unit Necker Cochin, APHP, the Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, and the Port-Royal Maternity Unit, Cochin Hospital, APHP, Paris, and the Department of Obstetrics and Gynecology, CHU Toulouse, Toulouse, and the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
出版信息
Obstet Gynecol. 2022 Dec 1;140(6):958-964. doi: 10.1097/AOG.0000000000004993. Epub 2022 Nov 2.
OBJECTIVE
To characterize the strength and patterns of association between birth weights and severe postpartum hemorrhage in twin pregnancies.
METHODS
This was a secondary analysis of the JUMODA (JUmeaux Mode d'Accouchement) cohort, a national, prospective, population-based study of twin deliveries, conducted from February 2014 to March 2015 in France. We excluded patients with a fetal death, medically indicated termination of pregnancy, antepartum hemorrhage, placenta previa, placental abruption, or missing birth weight. The primary outcome was severe postpartum hemorrhage , defined as a postpartum hemorrhage requiring at least one of the following: transfusion of 4 or more units of red blood cells, uterine artery embolization, uterine balloon tamponade, vascular ligation, uterine suture, emergency hysterectomy, admission to an intensive care unit, or postpartum hemorrhage considered severe by the obstetrician or leading to maternal death. The exposure was the sum of the birth weights of the two twins. To assess the association between the sum of twins' birth weights and severe postpartum hemorrhage, we used multilevel multivariable modified Poisson regression modeling. Analyses were conducted for the overall population and by planned and actual mode of delivery.
RESULTS
A total of 8,373 patients were analyzed. Severe postpartum hemorrhage occurred in 4.5% (379/8,372, 95% CI 4.1-5.0), from 2.1% (15/722) for a sum of twins' birth weights less than 3,000 g up to 8.8% (12/136) for a sum exceeding 6,500 g. In the multivariable analysis, the association between the sum of the twins' birth weights and severe postpartum hemorrhage was linear, with an adjusted relative risk of severe postpartum hemorrhage of 1.36 (95% CI 1.24-1.49) for each 500-g increase in the sum of twins' birth weights.
CONCLUSION
In twin pregnancies, the risk of severe postpartum hemorrhage increased linearly with the sum of the twins' birth weights.
目的
描述双胞胎妊娠中出生体重与重度产后出血之间的关联强度和模式。
方法
这是一项对 JUMODA（JUmeaux Mode d'Accouchement）队列的二次分析，该队列是一项全国性、前瞻性、基于人群的双胞胎分娩研究，于 2014 年 2 月至 2015 年 3 月在法国进行。我们排除了胎儿死亡、医学上需要终止妊娠、产前出血、前置胎盘、胎盘早剥或出生体重缺失的患者。主要结局为重度产后出血，定义为需要以下至少一种治疗的产后出血：输注 4 个或更多单位的红细胞、子宫动脉栓塞术、子宫球囊填塞、血管结扎、子宫缝合、紧急子宫切除术、入住重症监护病房，或由产科医生认为严重的产后出血或导致产妇死亡。暴露因素为两个双胞胎的出生体重总和。为评估双胞胎出生体重总和与重度产后出血之间的关联，我们使用多层次多变量改良泊松回归模型进行分析。分析针对总体人群以及计划和实际分娩方式进行。
结果
共分析了 8373 例患者。重度产后出血发生率为 4.5%（379/8372，95%CI 4.1-5.0），从双胞胎出生体重总和小于 3000 克的 2.1%（15/722）到总和超过 6500 克的 8.8%（12/136）。在多变量分析中，双胞胎出生体重总和与重度产后出血之间的关联呈线性，双胞胎出生体重总和每增加 500 克，重度产后出血的调整相对风险为 1.36（95%CI 1.24-1.49）。
结论
在双胞胎妊娠中，重度产后出血的风险随双胞胎出生体重总和的增加呈线性增加。
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