Clinical assessment indicators of postpartum hemorrhage: A systematic review

Ying Liu , Ying Shen , Wei Zhu , Jing-Bo Qiu , Qun Huang , Wen-Qin Ye
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引用次数: 7

Abstract

Objective

The assessment indicators of postpartum hemorrhage (PPH) were systematically reviewed to explore their relationship with blood loss as an early warning sign to identify potential PPH for prompt intervention.

Methods

A systematic literature search of 9 databases was conducted according to inclusion and exclusion criteria using a comprehensive strategy. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) strategy was chosen as the tool for quality assessment of included studies, and data concerning the basic study characteristics and assessment indicators were extracted.

Results

Eleven studies were included in this review. The assessment indicators in different reports covered heart rate, blood pressure, placental and birth canal check, hemoglobin (Hb), hematocrit (HCT), coagulation function tests, hemodynamic parameters and arterial blood gas, but no data on the assessment of postpartum uterine contraction were found. The relationship between indicators and blood loss varies. The overall quality of 9 manuscripts was comparatively high or moderate, and 2 were rated as low.

Conclusions

The association between blood loss and clinical symptoms is not conclusive based on the present studies, and specific cut-off points could not be formulated to determine the approximate amount of blood loss. However, some cut-off points can be considered warning signs for the need of advanced interventions, such as heart rate, prothrombin time, and placental implantation. Further research on comprehensive assessment and cut-off points should be performed such that birth attendants can distinguish PPH as early as possible.

产后出血临床评估指标的系统评价
目的对产后出血(PPH)的评价指标进行系统回顾,探讨其与产后出血的关系,作为产后出血的早期预警信号,发现潜在的PPH并及时干预。方法采用综合策略,根据纳入标准和排除标准对9个数据库进行系统文献检索。选择加强流行病学观察性研究报告(STROBE)策略作为纳入研究的质量评价工具,提取有关基本研究特征和评价指标的数据。结果本综述纳入了6项研究。不同报告的评估指标包括心率、血压、胎盘及产道检查、血红蛋白(Hb)、红细胞压积(HCT)、凝血功能检查、血流动力学参数、动脉血气等,但未发现产后子宫收缩的评估数据。各项指标与出血量的关系各不相同。9篇总体质量较高或中等,2篇质量较低。结论根据目前的研究,出血量与临床症状之间的关系尚不明确,也无法制定具体的分界点来确定出血量。然而,一些临界值可以被认为是需要进行高级干预的警告信号,如心率、凝血酶原时间和胎盘植入。应进一步研究综合评估和分界点,使助产士能够尽早区分PPH。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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