Saevarsdottir Karen Sol, Swift Emma M, Einarsdottir Kristjana, Gunnarsdottir Johanna
Faculty of Medicine, University of Iceland.
Faculty of Nursing and Midwifery, University of Iceland, Reykjavik Birth Center.
Laeknabladid. 2023 Jul;109(708):331-337. doi: 10.17992/lbl.2023.0708.751.
Many countries have reported an increased incidence proportion of postpartum hemorrhage (PPH). The proportion might also have increased at the National University Hospital of Iceland, based on the registration of the ICD-10 code O72. This study aimed to assess the incidence proportion and risk factors for ≥1000 ml PPH in singleton births in Iceland 2013-2018.
This population-based cohort study included data from the Icelandic Birth register on 21.110 singleton births in 2013-2018. Incidence proportion of PPH was assessed based on three definitions: PPH >500 ml, PPH ≥1000 ml, and O72. Binomial regression was used to assess both the change in the proportion of ≥1000 ml PPH over time, stratified by maternal BMI, and risk factors for ≥1000 ml PPH.
There was an inconsistency in the proportion of PPH when defined by blood loss >500 ml and O72. In obese women, PPH ≥1000 ml was more than twice as likely in those delivering in 2018 compared with 2013 (OR 2.23; CI 1.35-3.81). The strongest risk factors were emergency cesarean (OR 2.68; CI 2.22-3.22) and instrumental delivery (OR 2.18; CI 1.80-2.64), but macrosomia, primiparity and BMI ≥30 were also independent risk factors.
The incidence proportion of ≥1000 ml PPH has increased among obese women. The detrimental health effects of obesity and the increased prevalence of interventions among these women could explain these results. It is necessary to use registered blood loss in milliliters in the Icelandic Birth Register because of the under-registration of the diagnostic code O72.
许多国家报告产后出血（PPH）的发病率有所上升。基于国际疾病分类第十版（ICD - 10）代码O72的登记情况，冰岛国立大学医院的这一比例可能也有所增加。本研究旨在评估2013 - 2018年冰岛单胎分娩中≥1000毫升产后出血的发病率及危险因素。
这项基于人群的队列研究纳入了冰岛出生登记处2013 - 2018年21110例单胎分娩的数据。根据三种定义评估产后出血的发病率：产后出血>500毫升、产后出血≥1000毫升和O72。采用二项式回归评估≥1000毫升产后出血比例随时间的变化（按产妇体重指数分层）以及≥1000毫升产后出血的危险因素。
当按失血>500毫升和O72定义时，产后出血的比例存在不一致。在肥胖女性中，2018年分娩者发生≥1000毫升产后出血的可能性是2013年分娩者的两倍多（比值比2.23；可信区间1.35 - 3.81）。最强的危险因素是急诊剖宫产（比值比2.68；可信区间2.22 - 3.22）和器械助产（比值比2.18；可信区间1.80 - 2.64），但巨大儿、初产和体重指数≥30也是独立危险因素。
肥胖女性中≥1000毫升产后出血的发病率有所上升。肥胖对健康的有害影响以及这些女性中干预措施患病率的增加可以解释这些结果。由于诊断代码O72登记不足，冰岛出生登记处有必要使用以毫升为单位登记的失血量。
