Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.
Medicina (Kaunas). 2023 Jun 15;59(6):1151. doi: 10.3390/medicina59061151.
Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206-3.912; = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869-9.030; < 0.001) and parity (OR: 1.701; 95% CI: 1.164-2.487; = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138-4.106; = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921-9.531; < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324-32.527; = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value.
产后出血 (PPH) 是一种产科急症，尽管 PPH 的死亡率有所下降，但它仍然是产科的一个挑战。本研究旨在评估原发性 PPH 的发生率，并探讨其潜在的危险因素和处理方法。
这是一项回顾性病例对照研究，纳入了 2015 年至 2021 年期间在希腊塞萨洛尼基亚里士多德大学第三妇产科因 PPH（出血量＞500ml，无论分娩方式如何）而接受治疗的所有病例（PPH）。病例与对照组的比例估计为 1:1。采用卡方检验来评估几个变量与 PPH 之间是否存在关系，同时还对 PPH 的某些原因进行了亚组多变量逻辑回归分析。
在研究期间，在总共 8545 例分娩中，有 219 例（2.5%）妊娠并发 PPH。母亲年龄＞35 岁（OR：2.172；95%CI：1.206-3.912； = 0.010）、早产（＜37 周）（OR：5.090；95%CI：2.869-9.030； ＜0.001）和多胎妊娠（OR：1.701；95%CI：1.164-2.487； = 0.006）被确定为 PPH 的危险因素。子宫收缩乏力是 54.8%的妇女发生 PPH 的主要原因，其次是胎盘残留占 30.5%。关于处理方法，57.9%（n=127）的妇女接受了宫缩药物治疗，而 7.3%（n=16）的妇女接受了剖宫产子宫切除术来控制 PPH。早产（OR：2.162；95%CI：1.138-4.106； = 0.019）和剖宫产分娩（OR：4.279；95%CI：1.921-9.531； ＜0.001）与更高的需要多种治疗方式相关。早产（OR：8.695；95%CI：2.324-32.527； = 0.001）被确定为产科子宫切除术的独立预测因素。从对 PPH 并发症的回顾性分析中，未发现产妇死亡。大多数 PPH 病例通过宫缩药物治疗得到了控制。母亲年龄较大、早产和多胎妊娠对 PPH 的发生有显著影响。需要进一步研究 PPH 的危险因素，同时建立有效的预测模型将具有重要价值。
