Association of Labor Neuraxial Analgesia with Maternal Blood Transfusion.
Association of Labor Neuraxial Analgesia with Maternal Blood Transfusion.
复制标题
分娩椎管内镇痛与母体输血的关联。
DOI：
10.1097/aln.0000000000004743
复制
发表时间：
2023
期刊：
影响因子：
8.8
通讯作者：
Li,Guohua
中科院分区：
文献类型：
--
作者：
Guglielminotti,Jean;Landau,Ruth;Daw,Jamie;Friedman,AlexanderM;Li,Guohua
在美国，分娩镇痛用于大约70%的分娩。它可能有助于降低产后出血的风险，产后出血是分娩期间需要输血的母亲的最强指征。这项研究分析了分娩镇痛与产妇输血之间的联系，使用的数据来自2015年1月至2018年12月所有50个州和哥伦比亚特区的阴道（VD）和产时剖宫产（CD）分娩的国家生命统计系统出生文件的出生证明。数据被排除，如果他们有以下任何类别的信息缺失：分娩镇痛，产妇结局，产妇种族，或居住地或医院县和种族。其他的排除标准是如果母亲不住在美国或者孩子不是在医院出生的，分娩镇痛是关注的暴露，并在出生证明上的特定复选框中报告，而关注的主要结局是母体输血，也在特定复选框中报告。采用倾向评分匹配法估计与椎管内镇痛相关的输血的校正优势比和95% CI。对这些估计值进行了总体分析，并基于分娩方式，使用相互作用项比较VD和产时CD。使用反向倾向评分加权和定量偏倚分析进行敏感性分析，以解决任何错误分类的结局。
Labor neuraxial analgesia is used in about 70% of births in the United States. It may help lower the risk of postpartum hemorrhage, which is the strongest indication for a mother requiring a blood transfusion during childbirth. This study analyzed the link between labor neuraxial analgesia with maternal blood transfusion using data from birth certificates from the Natality File of the National Vital Statistics System for vaginal (VD) and intrapartum cesarean (CD) deliveries between January 2015 to December 2018 in all 50 states and the District of Columbia. Data were excluded if they had missing information in any of the following categories: labor neuraxial analgesia, maternal outcome, maternal ethnicity, or residence or hospital county and race. Other exclusion criteria were if the mother did not live in the United States or if a child was not birthed in a hospital.Labor neuraxial analgesia was the exposure of interest and is reported in a certain checkbox on birth certificates, whereas the main outcome of interest was maternal blood transfusion, which is also reported in a specific checkbox. Adjusted odds ratios and 95% CIs of blood transfusion connected with neuraxial analgesia were estimated using propensity score matching. These estimates were analyzed overall and based on delivery mode, with a comparison between VD and intrapartum CDs using an interaction term. Sensitivity analyses were conducted using inverse propensity score weighting and quantitative bias analysis to address any misclassified outcomes.