Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Int J Gynaecol Obstet. 2024 Aug;166(2):812-818. doi: 10.1002/ijgo.15414. Epub 2024 Feb 6.
To identify risk factors for developing early postpartum hemorrhage (PPH) and to examine whether risk factors vary according to severity and mode of delivery.
A population-based cohort study was conducted in which all deliveries at a tertiary medical center were included. Risk factors for developing early PPH were compared based on the severity of bleeding as well as the mode of delivery. Multiple logistic regression models were used to control for confounders.
Among 322 497 deliveries included in the analysis, early PPH complicated 1811 (0.56%) of all deliveries. Among all cases of early PPH, 505 deliveries (28%) were complicated with severe PPH. Using a logistic regression model, in vitro fertilization (IVF) pregnancy, previous cesarean delivery (CD), pre-eclampsia, placental abruption, and uterine rupture were independently associated only with severe early PPH, while non-progressive second stage of labor, induction of labor, and large for gestational age were independently associated with both severe and mild early PPH. When applying an additional logistic regression model, whereas IVF pregnancy, pre-eclampsia, and large for gestational age were independently associated with early PPH among vaginal deliveries only, placenta previa was independently associated with early PPH among CD only.
Independent risk factors for developing severe PPH solely include IVF pregnancy, previous CD, pre-eclampsia, placental abruption, and uterine rupture. IVF pregnancy, pre-eclampsia, and large for gestational age are independent risk factors for early PPH following vaginal delivery, while placenta previa is independently associated with early PPH after CD only. Due to the recognition of the importance of both the provider and institutional planning and preparation for PPH, the study's results should be viewed within the scope of its retrospective cohort design.
确定发生产后早期出血（PPH）的风险因素，并探讨这些风险因素是否因出血严重程度和分娩方式而异。
本研究为基于人群的队列研究，纳入了一家三级医疗中心的所有分娩。基于出血严重程度和分娩方式，比较了发生早期 PPH 的风险因素。采用多因素逻辑回归模型控制混杂因素。
在纳入分析的 322497 例分娩中，早期 PPH 使 1811 例（0.56%）分娩复杂化。在所有早期 PPH 病例中，505 例（28%）出现严重 PPH。使用逻辑回归模型，体外受精（IVF）妊娠、既往剖宫产（CD）、子痫前期、胎盘早剥和子宫破裂仅与严重早期 PPH 独立相关，而非进展性第二产程、引产和胎儿大于胎龄与严重和轻度早期 PPH 均独立相关。进一步应用逻辑回归模型后发现，IVF 妊娠、子痫前期和胎儿大于胎龄仅与阴道分娩的早期 PPH 独立相关，而前置胎盘仅与 CD 后的早期 PPH 独立相关。
发生严重 PPH 的独立危险因素仅包括 IVF 妊娠、既往 CD、子痫前期、胎盘早剥和子宫破裂。IVF 妊娠、子痫前期和胎儿大于胎龄是阴道分娩后发生早期 PPH 的独立危险因素，而前置胎盘仅与 CD 后发生早期 PPH 独立相关。鉴于提供者和机构对 PPH 的规划和准备的重要性，应在研究的回顾性队列设计范围内看待其结果。
