Botelho Amanda, Invitti Adriana Luckow, Mattar Rosiane, Pares David Baptista da Silva, Salmeron Camilla Parente, Caldas João Victor Jacomele, Mello Nathalia, Peixoto Alberto Borges, Araujo Júnior Edward, Sun Sue Yazaki
Department of Obstetrics Escola Paulista de Medicina Universidade Federal de São Paulo São PauloSP Brazil Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Department of Gynecology Escola Paulista de Medicina Universidade Federal de São Paulo São PauloSP Brazil Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Rev Bras Ginecol Obstet. 2024 Jun 27;46. doi: 10.61622/rbgo/2024rbgo53. eCollection 2024.
To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital.
We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression.
There were 11,935 deliveries during the study period. According to Robson's Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R Nagelkerke: 0.011, p<0.001] and birth weight [x(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653).
Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.
根据罗布森分类法评估低风险产科医院产后出血（PPH）的危险因素。
我们通过分析2019年11月至2021年11月期间在一家低风险产科医院就诊的孕妇病历进行回顾性队列研究。分析的变量包括：产妇年龄、分娩方式、出生体重、产次、罗布森分类法以及产后出血的原因。我们比较了自然分娩（第1组和第3组）和引产（第2a组和第4a组）孕妇产后出血的发生率。进行了卡方检验和学生t检验。使用二元逻辑回归比较变量。
研究期间共有11935例分娩。根据罗布森分类法，48.2%被归类为第1组和第3组（第I组：5750/11935），26.1%被归类为第2a组和第4a组（第II组：3124/11935）。第II组产后出血的患病率高于第I组（3.5%对2.7%，p=0.028）。引产使产后出血的发生率增加了18.8%（相对危险度：1.188，95%置信区间：1.02-1.36，p=0.030）。包括产钳助产[x(3)=10.6，比值比：7.26，95%置信区间：3.32-15.84，纳格尔科克R：0.011，p<0.001]和出生体重[x(4)=59.0，比值比：1.001，95%置信区间：1.001-1.001，纳格尔科克R：0.033，p<0.001]的模型是预测罗布森分类法第1、3、2a和4a组患者产后出血的最佳模型。出生体重对产后出血的预测能力较差（ROC曲线下面积：0.612，p<0.001，95%置信区间：0.572-0.653）。
罗布森分类法第2a和4a组产后出血率最高。包括产钳助产和出生体重的模型是罗布森分类法第1、3、2a和4a组产后出血的最佳预测模型。
