Jeffcoate T N, Miller J, Roos R F, Tindall V R
Br Med J. 1968 Oct 5;4(5622):19-25. doi: 10.1136/bmj.4.5622.19.
An analysis was made of 111 consecutive cases of puerperal thromboembolism by the age, parity, mode of delivery, and lactation habit of the women concerned, and the findings were compared with those from control groups.The statistics show that inhibition of lactation by means of ethinyloestradiol is associated with a threefold increase in thromboembolism, although the effect is seen mainly in women who have an operative delivery and who are aged more than 25 years. Among women aged more than 35 years who have an assisted delivery, inhibition of lactation is accompanied by a tenfold increase in the incidence of puerperal thromboembolism.Advancing age and operative intervention (especially caesarean section) are in themselves predisposing causes of deep venous thrombosis and embolism. They can also constitute indications for inhibiting lactation. This makes it difficult to assess whether the relation of thromboembolism to inhibition of lactation or to the administration of oestrogen is real or apparent. Doubts on the interpretation of the findings are raised by the fact that the number of fatal cases of puerperal thromboembolism in England and Wales, and of non-fatal cases in the hospitals under review, has not increased in recent years despite a progressive decrease in breast-feeding. Nevertheless, the evidence suggests that although the administration of ethinyloestradiol is not by itself enough to cause puerperal thromboembolism, it may be a factor which can tip the scales in women who are already predisposed to suffer this condition.Any thromboembolic hazard associated with administration of oestrogens for inhibiting lactation is probably acceptable except in women known to be at special risk by reason of age, operative delivery, obesity, and a past history of thromboembolic episodes.
对111例连续的产褥期血栓栓塞病例，根据相关女性的年龄、产次、分娩方式和哺乳习惯进行了分析，并将结果与对照组进行了比较。统计数据表明，通过乙炔雌二醇抑制泌乳与血栓栓塞增加两倍有关，尽管这种影响主要见于接受手术分娩且年龄超过25岁的女性。在年龄超过35岁且接受助产的女性中，抑制泌乳会使产褥期血栓栓塞的发生率增加九倍。年龄增长和手术干预（尤其是剖宫产）本身就是深静脉血栓形成和栓塞的易感因素。它们也可能构成抑制泌乳的指征。这使得难以评估血栓栓塞与抑制泌乳或雌激素给药之间的关系是真实的还是表面的。尽管近年来母乳喂养率逐渐下降，但英格兰和威尔士产褥期血栓栓塞的死亡病例数以及所审查医院的非死亡病例数并未增加，这一事实引发了对研究结果解释的质疑。然而，证据表明，虽然乙炔雌二醇本身不足以导致产褥期血栓栓塞，但它可能是一个因素，会使已经易患这种疾病的女性病情加重。除了已知因年龄、手术分娩、肥胖和既往有血栓栓塞发作史而处于特殊风险的女性外，与使用雌激素抑制泌乳相关的任何血栓栓塞风险可能都是可以接受的。
