Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, Koriyama city, Fukushima, Japan.
Department of Obstetrics and Gynecology, Iwase General Hospital, Sukagawa city, Fukushima, Japan.
PLoS One. 2024 Jul 9;19(7):e0306488. doi: 10.1371/journal.pone.0306488. eCollection 2024.
Given Japan's unique social background, it is critical to understand the current risk factors for postpartum hemorrhage (PPH) to effectively manage the condition, especially among specific groups. Therefore, this study aimed to identify the current risk factors for PPH during planned cesarean section (CS) in Japan. This multicenter retrospective cohort study was conducted in two tertiary maternal-fetal medicine units in Fukushima, Japan and included 1,069 women who underwent planned CS between January 1, 2013, and December 31, 2022. Risk factors for PPH (of > 1000 g and > 1500 g) were assessed using multivariate logistic regression analysis, considering variables such as maternal age, parity, assisted reproductive technology (ART) pregnancy, pre-pregnancy body mass index (BMI), uterine myoma, placenta previa, gestational age at delivery, birth weight categories, and hypertensive disorders of pregnancy (HDP). Multivariate linear regression analyses were conducted to predict estimated blood loss during planned CS. ART pregnancy, a pre-pregnancy BMI of 25.0-29.9 kg/m2, and uterine myoma increased PPH risk at various levels. Maternal smoking increased the risk of >1500 g PPH (adjusted odds ratio: 3.09, 95% confidence interval [CI]: 1.16-8.20). Multivariate linear analysis showed that advanced maternal age (B: 83 g; 95% CI: 27-139 g), ART pregnancy (B: 239 g; 95% CI: 121-357 g), pre-pregnancy BMI of 25.0-29.9 kg/m2 (B: 74 g; 95% CI: 22-167 g), uterine myoma (B: 151 g; 95% CI: 47-256 g), smoking (B: 107 g; 95% CI: 13-200 g), and birth weight > 3,500 g (B: 203 g; 95% CI: 67-338 g) were associated with blood loss during planned CS. Considering a patient's clinical characteristic may help predict bleeding in planned CSs and help improve patient safety.
鉴于日本独特的社会背景，了解产后出血（PPH）的当前风险因素对于有效管理该疾病至关重要，尤其是针对特定人群。因此，本研究旨在确定日本计划剖宫产（CS）中 PPH 的当前风险因素。这项多中心回顾性队列研究在日本福岛的两个三级母胎医学单位进行，纳入了 2013 年 1 月 1 日至 2022 年 12 月 31 日期间接受计划 CS 的 1069 名女性。使用多变量逻辑回归分析评估 PPH（>1000g 和>1500g）的风险因素，考虑了产妇年龄、产次、辅助生殖技术（ART）妊娠、孕前体重指数（BMI）、子宫肌瘤、前置胎盘、分娩时的胎龄、出生体重类别和妊娠高血压疾病（HDP）等变量。进行多变量线性回归分析以预测计划 CS 期间的估计失血量。ART 妊娠、孕前 BMI 为 25.0-29.9kg/m2 和子宫肌瘤增加了不同水平的 PPH 风险。母亲吸烟增加了>1500g PPH 的风险（调整后的优势比：3.09，95%置信区间[CI]：1.16-8.20）。多变量线性分析显示，高龄产妇（B：83g；95%CI：27-139g）、ART 妊娠（B：239g；95%CI：121-357g）、孕前 BMI 为 25.0-29.9kg/m2（B：74g；95%CI：22-167g）、子宫肌瘤（B：151g；95%CI：47-256g）、吸烟（B：107g；95%CI：13-200g）和出生体重>3500g（B：203g；95%CI：67-338g）与计划 CS 期间的失血量相关。考虑患者的临床特征可能有助于预测计划 CS 中的出血，并有助于提高患者安全性。
