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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 309 -314. doi: 10.3877/cma.j.issn.2096-1537.2021.04.005

临床研究

某三甲医院产后出血单中心回顾性分析
陈明月1, 周霞庆1, 李沂玮1, 朱英1, 胡炜1,()   
  1. 1. 310000 浙江大学医学院附属杭州市第一人民医院重症医学科
  • 收稿日期:2021-09-29 出版日期:2021-11-28
  • 通信作者: 胡炜

A retrospective study of postpartum hemorrhage in a tertiary hospital

Mingyue Chen1, Xiaqing Zhou1, Yiwei Li1, Ying Zhu1, Wei Hu1,()   

  1. 1. Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
  • Received:2021-09-29 Published:2021-11-28
  • Corresponding author: Wei Hu
引用本文:

陈明月, 周霞庆, 李沂玮, 朱英, 胡炜. 某三甲医院产后出血单中心回顾性分析[J/OL]. 中华重症医学电子杂志, 2021, 07(04): 309-314.

Mingyue Chen, Xiaqing Zhou, Yiwei Li, Ying Zhu, Wei Hu. A retrospective study of postpartum hemorrhage in a tertiary hospital[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 309-314.

目的

分析产后出血(PPH)患者的分娩临床特点、合并症及出血原因等,以降低PPH发生率,提高孕产妇生存率。

方法

选择2014年10月1日至2021年7月31日杭州市第一人民医院收住的产妇共计35 257例,其中PPH患者2528例。根据是否入住ICU,将其分为危重组(45例)和普通组(2483例),采用回顾性分析方法,收集2组患者临床资料,分析其年龄、出血病因、妊娠并发症、妊娠合并症、出血干预手段、输血量、妊娠方式、母儿预后等特点。

结果

患者PPH发病率为7.2%(2528/35 257),PPH危重率为1.8%(45/2528)。PPH患者中,危重组较普通组年龄大[31.0(28.0,34.5)岁vs 29.0(27.0,32.0)岁,P=0.041]、住院时间长[9.0(6.0,12.0)d vs 4.0(4.0,6.0)d,P<0.001]、胎儿死亡发生率高(22.2% vs 1.8%,P<0.001)、不良妊娠或宫内操作史多(60.0% vs 8.1%,P<0.001)、接受有创止血方式多(包括宫腔填塞术、子宫动脉栓塞术、子宫切除术和开腹止血术)(51.1% vs 1.4%,P<0.001)、妊娠并发症高(93.4% vs 15.7%,P<0.001)、妊娠合并症高(39.9% vs 3.6%,P<0.001),差异均有统计学意义。未发生PPH产妇死亡。

结论

PPH是一种产科急症,当产妇年龄大、有不良妊娠或宫内操作史、存在妊娠期合并症或并发症时更容易发展为危重症,若能及时获得有效治疗,预后较好。

Objective

To analyze the clinical characteristics, complications and bleeding causes of postpartum hemorrhage (PPH) patients, so as to reduce the occurrence of PPH and improve the maternal survival rate.

Methods

A total of 2528 PPH patients admitted to the First People's Hospital of Hangzhou from October 1, 2014 to July 31, 2021 were enrolled. According to whether they were admitted to ICU, the patients were divided into critical group (45 cases) and general group (2483 cases), and clinical data were collected. A retrospective study was conducted to analyze the characteristics of PPH patients, such as age, bleeding etiology, pregnancy complications, pregnancy complications, bleeding intervention methods, blood transfusion volume, pregnancy mode, maternal and infant prognosis.

Results

The incidence of PPH was 7.2%(2528/35257), and the critical rate of PPH was 1.8%(45/2528). In PPH patients, the critical group was older [31.0 (28.0, 34.5) years vs 29.0 (27.0, 32.0) years, P=0.041], and hospital stay [9.0 (6.0, 12.0) days vs 4.0 (4.0, 6.0) days, P<0.001], and incidence of fetal loss (22.2% vs 1.8%, P<0.001), adverse pregnancy or intrauterine procedure (60.0% vs 8.1%, P<0.001), invasive hemostasis (including uterine packing, uterine artery embolization, hysterectomy, and open hemostasis) (51.1% vs 1.4%, P<0.001), pregnancy complications (93.4% vs 15.7%, P<0.001) and pregnancy comorbidity (39.9% vs 3.6%, P<0.001) were significantly higher in critical group compared to general group. No PPH maternal deaths occurred.

Conclusion

Postpartum hemorrhage is an obstetric emergency. Higher the maternal age, adverse pregnancy or intrauterine operation history, pregnancy complications or complications are more likely to develop into critical disease. If timely and effective treatment were carried out, the prognosis is better.

表1 2组患者基本临床特征比较
表2 2组患者的妊娠并发症及妊娠合并症比较[例(%)]
表3 2组患者出血病因分析[2528例,例(%)]
1
Petersen EE, Davis NL, Goodman D, et al. Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 States, 2013-2017 [J]. MMWR Morb Mortal Wkly Rep, 2019, 68(18): 423-429.
2
Maswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum hemorrhage [J]. Int J Gynaecol Obstet, 2017, 137(1): 1-7.
3
Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage [J]. Obstet Gynecol, 2017, 130(4): e168-e186.
4
Reale SC, Easter SR, Xu X, et al. Trends in postpartum hemorrhage in the United States from 2010 to 2014 [J]. Anesth Analg, 2020, 130(5): e119-e122.
5
Sheldon WR, Blum J, Vogel JP, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health [J]. BJOG, 2014, 121(Suppl 1): 5-13.
6
王小娟, 谭红专, 周书进, 等. 湖南省浏阳市产妇产后出血发病率及其影响因素分析 [J]. 中南大学学报(医学版), 2014, 39(2): 151-156.
7
GBD 2015 Maternal Mortality Collaborators. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 [published correction appears in Lancet, 2017 Jan 7, 389(10064): e1] [J]. Lancet, 2016, 388(10053): 1775-1812.
8
Zaharatos J, St Pierre A, Cornell A, et al. Building U.S. capacity to review and prevent maternal deaths [J]. J Womens Health (Larchmt), 2018, 27(1): 1-5.
9
中华医学会重症医学分会. 中国重症加强治疗病房( ICU) 建设与管理指南( 2006) [J]. 中国危重病急救医学, 2006, 18(7): 387-388.
10
Lockwood CJ. Regulation of plasminogen activator inhibitor 1 expression by interaction of epidermal growth factor with progestin during decidualization of human endometrial stromal cells [J]. Am J Obstet Gynecol, 2001, 184(5): 798-805.
11
Allard S, Green L, Hunt BJ. How we manage the haematological aspects of major obstetric haemorrhage [J]. Br J Haematol, 2014, 164(2): 177-188.
12
Evensen A, Anderson JM, Fontaine P. Postpartum hemorrhage: prevention and treatment [J]. Am Fam Physician, 2017, 95(7): 442-449.
13
Sheiner E, Sarid L, Levy A, et al. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study [J]. J Matern Fetal Neonatal Med, 2005, 18(3): 149-154.
14
Mhyre JM, Shilkrut A, Kuklina EV, et al. Massive blood transfusion during hospitalization for delivery in New York State, 1998-2007 [J]. Obstet Gynecol, 2013, 122(6): 1288-1294.
15
Bateman BT, Berman MF, Riley LE, et al. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries [J]. Anesth Analg, 2010, 110(5): 1368-1373.
16
Rouse DJ, Leindecker S, Landon M, et al. The MFMU Cesarean Registry: uterine atony after primary cesarean delivery [J]. Am J Obstet Gynecol, 2005, 193(3 Pt 2): 1056-1060.
17
Cheng YW, Delaney SS, Hopkins LM, et al. The association between the length of first stage of labor, mode of delivery, and perinatal outcomes in women undergoing induction of labor [J]. Am J Obstet Gynecol, 2009, 201(5): 477.e1-7.
18
Blomberg M. Maternal obesity and risk of postpartum hemorrhage [J]. Obstet Gynecol, 2011, 118(3): 561-568.
19
Wetta LA, Szychowski JM, Seals S, et al. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery [J]. Am J Obstet Gynecol, 2013, 209(1): 51.e1-6.
20
Kramer MS, Berg C, Abenhaim H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage [J]. Am J Obstet Gynecol, 2013, 209(5): 449.e1-7.
21
Sharp GC, Saunders PT, Greene SA, et al. Intergenerational transmission of postpartum hemorrhage risk: analysis of 2 Scottish birth cohorts [J]. Am J Obstet Gynecol, 2014, 211(1): 51.e1-7.
22
Oberg AS, Hernandéz-Diaź S, Frisell T, et al. Genetic contribution to postpartum haemorrhage in Swedish population: cohort study of 466, 686 births [J]. BMJ, 2014, 349: g4984.
23
Skalkidou A, Sundström-Poromaa I, Wikman A, et al. SSRI use during pregnancy and risk for postpartum haemorrhage: a national register-based cohort study in Sweden [J]. BJOG, 2020, 127(11): 1366-1373.
24
Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: postpartum hemorrhage [J]. Obstet Gynecol, 2017, 130(4): e168-e186.
25
Diaz V, Abalos E, Carroli G. Methods for blood loss estimation after vaginal birth [J]. Cochrane Database Syst Rev, 2018, 9(9): CD010980.
26
Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage [J]. N Engl J Med, 2021, 384(17): 1635-1645.
27
Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis [J]. Am J Obstet Gynecol, 2020, 222(4): 293.e1-52.
28
Magwali TL, Butrick E, Ayadi AE, et al. A cluster randomized controlled trial of the non-pneumatic anti-shock garment for obstetric haemorrhage: sub-analysis of the Zimbabwean Arm [J]. Cent Afr J Med, 2015, 61(5-8): 27-32.
29
Mbaruku G, Therrien MS, Tillya R, et al. Implementation project of the non-pneumatic anti-shock garment and m-communication to enhance maternal health care in rural Tanzania [J]. Reprod Health, 2018, 15(1): 177.
30
Ding XX, Xu SJ, Hao JH, et al. Maternal pre-pregnancy BMI and adverse pregnancy outcomes among Chinese women: Results from the C-ABCS [J]. J Obstet Gynaecol, 2016, 36(3): 328-332.
31
Yogev , Chen , Hod , et al; Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Copperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: preeclampsia [J]. Am J Obstet Gynecol, 2010, 202(3): 255.e1-7.
32
Carpenter MW. Gestational diabetes, pregnancy hypertension, and late vascular disease [published correction appears in Diabetes Care, 2007 Dec, 30(12): 3154] [J]. Diabetes Care, 2007, 30 (Suppl 2): S246-S250.
33
Bryson CL, Ioannou GN, Rulyak SJ, et al. Association between gestational diabetes and pregnancy-induced hypertension [J]. Am J Epidemiol, 2003, 158(12): 1148-1153.
34
Shoham I, Wiznitzer A, Silberstein T, et al. Gestational diabetes complicated by hydramnios was not associated with increased risk of perinatal morbidity and mortality [J]. Eur J Obstet Gynecol Reprod Biol, 2001, 100(1): 46-49.
35
Pilliod RA, Page JM, Burwick RM, et al. The risk of fetal death in nonanomalous pregnancies affected by polyhydramnios [J]. Am J Obstet Gynecol, 2015, 213(3): 410.e1-6.
36
Boney CM, Verma A, Tucker R, et al. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus [J]. Pediatrics, 2005, 115(3): e290-e296.
37
Zwart JJ, Richters JM, Ory F, et al. Uterine rupture in the Netherlands: a nationwide population-based cohort study [J]. BJOG, 2009, 116(8): 1069-1080.
38
Zhao Z, Han S, Yao G, et al. Pregnancy-related ICU admissions from 2008 to 2016 in China: a first multicenter report [J]. Crit Care Med, 2018, 46(10): e1002-e1009.
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