School of Nursing, Wuhan University, Wuhan, China.
Hangzhou Women's Hospital, Hangzhou, China.
J Obstet Gynaecol Res. 2023 Jul;49(7):1663-1676. doi: 10.1111/jog.15654. Epub 2023 Apr 17.
To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery.
A systematic review and meta-analysis was conducted. PubMed, Cochrane Library, CINAHL, Web of Science, EMBASE, and ClinicalTrials.gov databases were systematically searched from inception to April 30th, 2022. Cross-sectional, cohort, case-control, and secondary analysis of randomized controlled studies that reported the incidence of PPH and the related risk factors in vaginal delivery were eligible through screening of 2343 articles. The incidence, associated standard error, adjusted odds ratios, relative risks and associated 95% confidence intervals were combined in the meta-analysis.
Thirty-six articles were included in the descriptive review. The incidence of PPH (blood loss ≥500 mL and blood loss ≥1000 mL) was 17% and 6%, respectively. Forty-one identified risk factors were divided into five categories under two criteria: history and demographics; maternal comorbidity; pregnancy-related factors; labor-related factors; delivery-related factors.
With the increasing incidence of PPH globally, obstetric health care providers need to improve their awareness of these multi-factorial risks to optimize obstetric care and reduce maternal morbidity. This systematic review and meta-analysis have raised important questions about the nature of vaginal delivery, such as the duration of prolonged labor, details on the use of oxytocin, and the presence of genital tract trauma. There should be highlighted by obstetric personnel on these factors during a patients' labor process.
估计阴道分娩后产后出血（PPH）的发生率并确定其危险因素。
系统综述和荟萃分析。通过对 2343 篇文章的筛选，检索了 PubMed、Cochrane 图书馆、CINAHL、Web of Science、EMBASE 和 ClinicalTrials.gov 数据库，以获取从成立到 2022 年 4 月 30 日发表的报告阴道分娩中 PPH 发生率和相关危险因素的横断面、队列、病例对照和随机对照研究的二次分析。对纳入的研究进行 Meta 分析，合并发生率、相关标准误、调整后的优势比、相对风险及其 95%置信区间。
36 篇文章纳入描述性综述。PPH（出血量≥500mL 和出血量≥1000mL）的发生率分别为 17%和 6%。确定了 41 个危险因素，根据两个标准分为五类：既往史和人口统计学；母体合并症；妊娠相关因素；产程相关因素；分娩相关因素。
随着全球 PPH 发生率的增加，产科保健提供者需要提高对这些多因素风险的认识，以优化产科护理，降低产妇发病率。本系统评价和荟萃分析提出了一些关于阴道分娩性质的重要问题，例如产程延长的持续时间、催产素使用的详细情况以及生殖道创伤的存在。在患者分娩过程中，产科人员应该关注这些因素。
