Federal Medical Centre, Owo, Nigeria.
Lagos State University Teaching Hospital, Ikeja, Nigeria.
BJOG. 2024 Aug;131 Suppl 3:64-77. doi: 10.1111/1471-0528.17822. Epub 2024 Apr 30.
To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria.
A secondary data analysis using a cross-sectional design.
Referral-level hospitals (48 public and six private facilities).
Women admitted for birth between 1 September 2019 and 31 August 2020.
Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model.
Prevalence of PPH and maternal and neonatal outcomes.
Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions.
A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.
在尼日利亚的一项多中心研究中，确定主要产后出血（PPH）的流行率、风险因素以及母婴结局。
使用横断面设计的二次数据分析。
转诊水平的医院（48 家公立和 6 家私立机构）。
2019 年 9 月 1 日至 2020 年 8 月 31 日期间因分娩而入院的女性。
利用尼日利亚母婴和围产数据库质量、公平和尊严计划在 1 年期间收集的数据，按分娩方式（阴道或剖宫产）进行分层，使用混合效应逻辑回归模型进行分析。
PPH 的发生率和母婴结局。
在 68754 名女性中，有 2169 名（3.2%，95%置信区间 3.07%-3.30%）发生 PPH，其中阴道分娩和剖宫产的发生率分别为 2.7%（95%置信区间 2.55%-2.85%）和 4.0%（95%置信区间 3.75%-4.25%）。与阴道分娩后 PPH 相关的因素包括：未接受正规教育（调整比值比[aOR]2.2，95%置信区间 1.8-2.6，P<0.001）；多胎妊娠（aOR 2.7，95%置信区间 2.1-3.5，P<0.001）；和产前出血（aOR 11.7，95%置信区间 9.4-14.7，P<0.001）。剖宫产相关的 PPH 发生因素包括：母亲年龄>35 岁（aOR 1.7，95%置信区间 1.5-2.0，P<0.001）；从非正式场所转诊（aOR 2.4，95%置信区间 1.4-4.0，P=0.002）；和产前出血（aOR 3.7，95%置信区间 2.8-4.7，P<0.001）。总体而言，4.8%（104/2169）的分娩发生了产妇死亡，其中 101 名（101/1182）入住重症监护病房。所有婴儿中有四分之一为死产（570/2307），占新生儿重症监护病房收治人数的 23.9%（429/1796）。
提高熟练助产士的可及性可降低 3.2%的 PPH 发生率。
