Emily M S Miller, Allie Sakowicz, Elise Leger, Elizabeth Lange, Lynn M Yee
{"title":"产前服用硫酸镁与产后出血之间的关系。","authors":"Emily M S Miller, Allie Sakowicz, Elise Leger, Elizabeth Lange, Lynn M Yee","doi":"10.1055/s-0040-1721671","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objective</b> The aim of the study is to investigate the association between intrapartum administration of magnesium sulfate in women with hypertensive disorders of pregnancy and postpartum hemorrhage. <b>Study Design</b> This was a retrospective cohort study of women diagnosed with a hypertensive disorder of pregnancy who delivered singleton gestations >32 weeks at a single, large volume tertiary care center between January 2006 and February 2015. Women who received intrapartum magnesium sulfate for seizure prophylaxis were compared with women who did not receive intrapartum magnesium sulfate. The primary outcome was frequency of postpartum hemorrhage. Secondary outcomes included estimated blood loss, uterine atony, and transfusion of packed red blood cells. Bivariable analyses were used to compare the frequencies of each outcome. Multivariable logistic regression models examined the independent associations of magnesium sulfate with outcomes. <b>Results</b> Of 2,970 women who met inclusion criteria, 1,072 (36%) received intrapartum magnesium sulfate. Women who received magnesium sulfate were more likely to be nulliparous, publicly insured, of minority race or ethnicity, earlier gestational age at delivery, and undergo labor induction. The frequency of postpartum hemorrhage was significantly higher among women who received magnesium sulfate compared with those who did not (12.4 vs. 9.3%, <i>p</i> = 0.008), which persisted after controlling for potential confounders. Of secondary outcomes, there was no difference in estimated blood loss between women who did and did not receive magnesium sulfate (250 mL [interquartile range 250-750] vs. 250 mL [interquartile range 250-750], <i>p</i> = 0.446). However, compared with women who did not receive magnesium sulfate, women who received magnesium sulfate had a greater frequency of uterine atony (8.9 vs 4.9%, <i>p</i> < 0.001) and transfusion of packed red blood cells (2.0 vs. 0.8%, <i>p</i> = 0.008). These differences persisted after controlling for potential confounders. <b>Conclusion</b> Intrapartum magnesium sulfate administration to women with hypertensive disorders of pregnancy is associated with increased odds of postpartum hemorrhage, uterine atony, and red blood cell transfusion.</p>","PeriodicalId":7645,"journal":{"name":"AJP Reports","volume":"11 1","pages":"e21-e25"},"PeriodicalIF":0.8000,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/66/10-1055-s-0040-1721671.PMC7850913.pdf","citationCount":"0","resultStr":"{\"title\":\"Association between Receipt of Intrapartum Magnesium Sulfate and Postpartum Hemorrhage.\",\"authors\":\"Emily M S Miller, Allie Sakowicz, Elise Leger, Elizabeth Lange, Lynn M Yee\",\"doi\":\"10.1055/s-0040-1721671\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Objective</b> The aim of the study is to investigate the association between intrapartum administration of magnesium sulfate in women with hypertensive disorders of pregnancy and postpartum hemorrhage. <b>Study Design</b> This was a retrospective cohort study of women diagnosed with a hypertensive disorder of pregnancy who delivered singleton gestations >32 weeks at a single, large volume tertiary care center between January 2006 and February 2015. Women who received intrapartum magnesium sulfate for seizure prophylaxis were compared with women who did not receive intrapartum magnesium sulfate. The primary outcome was frequency of postpartum hemorrhage. Secondary outcomes included estimated blood loss, uterine atony, and transfusion of packed red blood cells. Bivariable analyses were used to compare the frequencies of each outcome. Multivariable logistic regression models examined the independent associations of magnesium sulfate with outcomes. <b>Results</b> Of 2,970 women who met inclusion criteria, 1,072 (36%) received intrapartum magnesium sulfate. Women who received magnesium sulfate were more likely to be nulliparous, publicly insured, of minority race or ethnicity, earlier gestational age at delivery, and undergo labor induction. The frequency of postpartum hemorrhage was significantly higher among women who received magnesium sulfate compared with those who did not (12.4 vs. 9.3%, <i>p</i> = 0.008), which persisted after controlling for potential confounders. Of secondary outcomes, there was no difference in estimated blood loss between women who did and did not receive magnesium sulfate (250 mL [interquartile range 250-750] vs. 250 mL [interquartile range 250-750], <i>p</i> = 0.446). However, compared with women who did not receive magnesium sulfate, women who received magnesium sulfate had a greater frequency of uterine atony (8.9 vs 4.9%, <i>p</i> < 0.001) and transfusion of packed red blood cells (2.0 vs. 0.8%, <i>p</i> = 0.008). These differences persisted after controlling for potential confounders. <b>Conclusion</b> Intrapartum magnesium sulfate administration to women with hypertensive disorders of pregnancy is associated with increased odds of postpartum hemorrhage, uterine atony, and red blood cell transfusion.</p>\",\"PeriodicalId\":7645,\"journal\":{\"name\":\"AJP Reports\",\"volume\":\"11 1\",\"pages\":\"e21-e25\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2021-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/66/10-1055-s-0040-1721671.PMC7850913.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"AJP Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1055/s-0040-1721671\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/2/1 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AJP Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0040-1721671","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/2/1 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
研究目的 研究妊娠高血压疾病妇女产前服用硫酸镁与产后出血之间的关系。研究设计 这是一项回顾性队列研究,研究对象是 2006 年 1 月至 2015 年 2 月期间在一家大型三级医疗中心分娩的妊娠期大于 32 周的单胎妊娠妇女。研究人员将接受产前硫酸镁预防癫痫发作的产妇与未接受产前硫酸镁预防癫痫发作的产妇进行了比较。主要结果是产后出血频率。次要结果包括估计失血量、子宫失弛缓和输注包装红细胞。二变量分析用于比较每种结果的发生频率。多变量逻辑回归模型检验了硫酸镁与结果之间的独立关联。结果 在符合纳入标准的 2,970 名产妇中,1,072 人(36%)接受了产前硫酸镁治疗。接受硫酸镁治疗的产妇更有可能是非妊娠、有公共保险、少数种族或族裔、分娩时胎龄较小、接受过引产手术。与未服用硫酸镁的产妇相比,服用硫酸镁的产妇产后出血的频率明显更高(12.4% 对 9.3%,P = 0.008),在控制了潜在的混杂因素后,这种情况依然存在。在次要结果中,接受和未接受硫酸镁治疗的妇女在估计失血量方面没有差异(250 mL [四分位间范围 250-750] vs. 250 mL [四分位间范围 250-750], p = 0.446)。然而,与未接受硫酸镁治疗的妇女相比,接受硫酸镁治疗的妇女发生子宫失弛缓的频率更高(8.9% 对 4.9%,P = 0.008)。在控制了潜在的混杂因素后,这些差异依然存在。结论 患有妊娠高血压疾病的妇女在产前服用硫酸镁与产后出血、子宫收缩和输红细胞的几率增加有关。
Association between Receipt of Intrapartum Magnesium Sulfate and Postpartum Hemorrhage.
Objective The aim of the study is to investigate the association between intrapartum administration of magnesium sulfate in women with hypertensive disorders of pregnancy and postpartum hemorrhage. Study Design This was a retrospective cohort study of women diagnosed with a hypertensive disorder of pregnancy who delivered singleton gestations >32 weeks at a single, large volume tertiary care center between January 2006 and February 2015. Women who received intrapartum magnesium sulfate for seizure prophylaxis were compared with women who did not receive intrapartum magnesium sulfate. The primary outcome was frequency of postpartum hemorrhage. Secondary outcomes included estimated blood loss, uterine atony, and transfusion of packed red blood cells. Bivariable analyses were used to compare the frequencies of each outcome. Multivariable logistic regression models examined the independent associations of magnesium sulfate with outcomes. Results Of 2,970 women who met inclusion criteria, 1,072 (36%) received intrapartum magnesium sulfate. Women who received magnesium sulfate were more likely to be nulliparous, publicly insured, of minority race or ethnicity, earlier gestational age at delivery, and undergo labor induction. The frequency of postpartum hemorrhage was significantly higher among women who received magnesium sulfate compared with those who did not (12.4 vs. 9.3%, p = 0.008), which persisted after controlling for potential confounders. Of secondary outcomes, there was no difference in estimated blood loss between women who did and did not receive magnesium sulfate (250 mL [interquartile range 250-750] vs. 250 mL [interquartile range 250-750], p = 0.446). However, compared with women who did not receive magnesium sulfate, women who received magnesium sulfate had a greater frequency of uterine atony (8.9 vs 4.9%, p < 0.001) and transfusion of packed red blood cells (2.0 vs. 0.8%, p = 0.008). These differences persisted after controlling for potential confounders. Conclusion Intrapartum magnesium sulfate administration to women with hypertensive disorders of pregnancy is associated with increased odds of postpartum hemorrhage, uterine atony, and red blood cell transfusion.