PDF(Pubmed)
Abstract：
Given Japan\'s unique social background, it is critical to understand the current risk factors for postpartum hemorrhage (PPH) to effectively manage the condition, especially among specific groups. Therefore, this study aimed to identify the current risk factors for PPH during planned cesarean section (CS) in Japan. This multicenter retrospective cohort study was conducted in two tertiary maternal-fetal medicine units in Fukushima, Japan and included 1,069 women who underwent planned CS between January 1, 2013, and December 31, 2022. Risk factors for PPH (of > 1000 g and > 1500 g) were assessed using multivariate logistic regression analysis, considering variables such as maternal age, parity, assisted reproductive technology (ART) pregnancy, pre-pregnancy body mass index (BMI), uterine myoma, placenta previa, gestational age at delivery, birth weight categories, and hypertensive disorders of pregnancy (HDP). Multivariate linear regression analyses were conducted to predict estimated blood loss during planned CS. ART pregnancy, a pre-pregnancy BMI of 25.0-29.9 kg/m2, and uterine myoma increased PPH risk at various levels. Maternal smoking increased the risk of >1500 g PPH (adjusted odds ratio: 3.09, 95% confidence interval [CI]: 1.16-8.20). Multivariate linear analysis showed that advanced maternal age (B: 83 g; 95% CI: 27-139 g), ART pregnancy (B: 239 g; 95% CI: 121-357 g), pre-pregnancy BMI of 25.0-29.9 kg/m2 (B: 74 g; 95% CI: 22-167 g), uterine myoma (B: 151 g; 95% CI: 47-256 g), smoking (B: 107 g; 95% CI: 13-200 g), and birth weight > 3,500 g (B: 203 g; 95% CI: 67-338 g) were associated with blood loss during planned CS. Considering a patient\'s clinical characteristic may help predict bleeding in planned CSs and help improve patient safety.
摘要：
鉴于日本独特的社会背景，了解当前产后出血（PPH）的危险因素对有效管理病情至关重要，特别是在特定群体中。因此,本研究旨在确定日本计划剖宫产术(CS)中PPH的当前危险因素.这项多中心回顾性队列研究是在福岛的两个三级母胎医学单位进行的，日本包括1,069名在2013年1月1日至2022年12月31日期间接受计划CS的女性。PPH（>1000g和>1500g）的危险因素使用多变量逻辑回归分析进行评估。考虑到诸如产妇年龄等变量，奇偶校验，辅助生殖技术（ART）怀孕，孕前体重指数(BMI),子宫肌瘤,前置胎盘,分娩时的胎龄，出生体重类别，和妊娠高血压疾病（HDP）。进行多元线性回归分析以预测计划CS期间的估计失血量。ART怀孕，孕前BMI为25.0-29.9kg/m2,子宫肌瘤会增加不同水平的PPH风险.母亲吸烟会增加>1500gPPH的风险（调整后的比值比：3.09，95％置信区间[CI]：1.16-8.20）。多元线性分析显示，高龄孕产妇（B：83g；95％CI：27-139g），ART妊娠（B：239g；95％CI：121-357g），孕前BMI为25.0-29.9kg/m2（B：74g；95％CI：22-167g），子宫肌瘤（B：151g；95%CI：47-256g），吸烟（B：107克；95%CI：13-200克），出生体重>3,500g(B:203g;95%CI:67-338g)与计划CS期间失血相关。考虑患者的临床特征可能有助于预测计划CSs中的出血，并有助于提高患者的安全性。
