剖宫产期间大出血产妇的产科干预措施及病发率
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Obstetric interventions and maternal morbidity among women who experience severe postpartum hemorrhage during cesarean delivery
背景与目的:与顺产相比，剖宫产产妇产后出血风险增加。产前剖宫产与产时剖宫产产妇管理措施可能有所不同。在两组不同剖宫产队列中，我们研究了产后大出血产妇的外科干预措施、血制品的使用以及产妇预后。
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方法：我们对2002年至2012年间在美国三级产科中心行产前或产后剖宫产的两个队列进行二次分析。产后大出血的定义为失血量≥1500ml或术后48h内需要输注红细胞。我们研究了血制品成分使用、医疗及外科干预措施及产妇预后。
结果：产前剖宫产队列包括269名产妇，而产后剖宫产队列包括278名产妇。产前剖宫产队列中，33.3%的产妇分别在术中或术后接受了红细胞输注。产后剖宫产队列中，18%的产妇术中接收红细胞输注，术后44%的产妇接受了红细胞输注。甲基麦角新碱是最常用的二线宫缩剂（百分比分别为33%和43%）。产前剖宫产产妇的病发率最高，18%的产妇需要进行子宫切除及16%产妇需要进入ICU进行监护管理。
结论：我们的研究为剖宫产期间大出血产妇的输血及外科干预措施提供了一定的指导意见。但是为了研究此情况下血制品使用和外科干预措施的最佳方案，需进一步大规模的研究探讨。
K. Seligman,B. Ramachandran,P. Hegde,E.T. Riley,Y.Y.El-Sayed,L.M. Nelson,A.J. Butwick； Obstetric interventions and maternal morbidity among women who experience severe postpartum hemorrhage during cesarean delivery；International Journal of Obstetric Anesthesia (2017) 31, 27–36 0959-289X/$
Background: Compared to vaginal delivery, women undergoing cesarean delivery are at increased risk of postpartum hemorrhage.Management approaches may differ between those undergoing prelabor cesarean delivery compared to intrapartum cesarean delivery. We examined surgical interventions, blood component use, and maternal outcomes among those experiencing severe postpartum hemorrhage within the two distinct cesarean delivery cohorts.
Methods: We performed secondary analyses of data from two cohorts who underwent prelabor cesarean delivery or intrapartum cesarean delivery at a tertiary obstetric center in the United States between 2002 and 2012. Severe postpartum hemorrhage was classified as an estimated blood loss _1500 mL or receipt of a red blood cell transfusion up to 48 h post-cesarean delivery. We examined blood component use, medical and surgical interventions and maternal outcomes.
Results: The prelabor cohort comprised 269 women and the intrapartum cohort comprised 278 women. In the prelabor cohort, one third of women received red blood cells intraoperatively or postoperatively, respectively. In the intrapartum cohort, 18% women received red blood cells intraoperatively vs. 44% postoperatively (P <0.001). In the prelabor and intrapartum cohorts, methylergonovine was the most common second-line uterotonic (33% and 43%, respectively). Women undergoing prelabor cesarean delivery had the highest rates of morbidity, with 18% requiring hysterectomy and 16% requiring intensive care admission.
Conclusion: Our findings provide a snapshot of contemporary transfusion and surgical practices for severe postpartum hemorrhage management during cesarean delivery. To determine optimal transfusion and management practices in this setting, large pragmatic studies are needed.
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