当前位置： SCI文献检索 > AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY期刊下所有文献 > Incidence, risk factors, and temporal trends in severe postpartum hemorrhage.

Incidence, risk factors, and temporal trends in severe postpartum hemorrhage.

Abstract：

OBJECTIVE:Because the diagnosis of postpartum hemorrhage (PPH) depends on the accoucheur's subjective estimate of blood loss and varies according to mode of delivery, we examined temporal trends in severe PPH, defined as PPH plus receipt of a blood transfusion, hysterectomy, and/or surgical repair of the uterus. STUDY DESIGN:We analyzed 8.5 million hospital deliveries in the US Nationwide Inpatient Sample from 1999 to 2008 for temporal trends in, and risk factors for, severe PPH, based on International Classification of Diseases, 9th revision, clinical modification diagnosis and procedure codes. Sequential logistic regression models that account for the stratified random sampling design were used to assess the extent to which changes in risk factors explain the trend in severe PPH. RESULTS:Of the total 8,571,209 deliveries, 25,906 (3.0 per 1000) were complicated by severe PPH. The rate rose from 1.9 to 4.2 per 1000 from 1999 to 2008 (P for yearly trend < .0001), with increases in severe atonic and nonatonic PPH, due especially to PPH with transfusion, but also PPH with hysterectomy. Significant risk factors included maternal age ≥35 years (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.5-1.6), multiple pregnancy (aOR, 2.8; 95% CI, 2.6-3.0), fibroids (aOR, 2.0; 95% CI, 1.8-2.2), preeclampsia (aOR, 3.1; 95% CI, 2.9-3.3), amnionitis (aOR, 2.9; 95% CI, 2.5-3.4), placenta previa or abruption (aOR, 7.0; 95% CI, 6.6-7.3), cervical laceration (aOR, 94.0; 95% CI, 87.3-101.2), uterine rupture (aOR, 11.6; 95% CI, 9.7-13.8), instrumental vaginal delivery (aOR, 1.5; 95% CI, 1.4-1.6), and cesarean delivery (aOR, 1.4; 95% CI, 1.3-1.5). Changes in risk factors, however, accounted for only 5.6% of the increase in severe PPH. CONCLUSION:A doubling in incidence of severe PPH over 10 years was not explained by contemporaneous changes in studied risk factors.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Kramer MS,Berg C,Abenhaim H,Dahhou M,Rouleau J,Mehrabadi A,Joseph KS

doi

10.1016/j.ajog.2013.07.007

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

449.e1-7

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(13)00739-4

journal_volume

209

pub_type

杂志文章

在线工具

Incidence, risk factors, and temporal trends in severe postpartum hemorrhage.