继发性产后出血:发病率、发病率及目前的处理

Fatemeh Hoveyda , I.Z MacKenzie
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引用次数: 0

摘要

目的探讨继发性产后出血的发生率、危险因素、临床表现、治疗及发病率。设计分析132名连续三年出现继发性产后出血的妇女。某地区综合教学医院的产科每年为约6500名妇女提供服务。主要结局测量与出血原因相关的因素和由此引起的发病率。结果大多数妇女在分娩后第二周出现。产后出血史(OR 9.3;95% CI 6.2-14.0)和人工移除胎盘(OR 3.5;95% CI 1.6-7.5)是唯一确定的显著危险因素。有很高的相关发病率,84%需要住院,63%手术撤离,17%输血,3名妇女出现子宫穿孔,1名接受子宫切除术。在仅接受疏散的妇女中,37%的人术后确认保留了胎盘组织;术前超声检查并没有提供比临床评估更好的鉴别这一发现。结论继发性产后出血发生率不到1%,与原发性产后出血和胎盘残留有关,可能导致严重的产妇发病率。这个问题应该得到比近年来更多的关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Secondary postpartum haemorrhage: incidence, morbidity and current management

Objective To determine the incidence, risk factors, presentation, treatment and morbidity associated with secondary postpartum haemorrhage.

Design Analysis of 132 consecutive women presenting with secondary postpartum haemorrhage occurring over a three-year period.

Setting The maternity unit in a district general teaching hospital serving an annual delivery rate of around 6500 women.

Main outcome measures Factors associated with the cause of the haemorrhage and the resulting morbidity.

Results Most women presented during the second week after delivery. A history of primary postpartum haemorrhage (OR 9.3; 95% CI 6.2-14.0) and manual removal of placenta (OR 3.5; 95% CI 1.6-7.5) were the only significant risk factors identified. There was a high associated morbidity, with 84% requiring hospital admission, 63% surgical evacuation, 17% blood transfusion, with three women suffering a uterine perforation, one managed by hysterectomy. In women undergoing evacuation only, 37% had retained placental tissue confirmed after surgery; pre-operative ultrasound examination did not provide a better discrimination over clinical assessment for this finding.

Conclusions Secondary postpartum haemorrhage occurs in just under 1% of women, is associated with primary postpartum haemorrhage and retained placenta, and may result in significant maternal morbidity. This problem deserves more attention than it has received in recent years.

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