Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study
Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study
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DOI：
10.1111/j.1471-0528.2011.03198.x
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发表时间：
2012-02-01
影响因子：
5.8
通讯作者：
Greene, R. A.
中科院分区：
文献类型：
--
作者：
Lutomski, J. E.;Byrne, B. M.;Greene, R. A.
目的分析全国产后出血（PPH）的发生率，探讨PPH的发生趋势与分娩方式、输血和胎盘粘连的关系（accreta，方法国际疾病分类（ICD）-9-CM和ICD-10-CM，以爱尔兰共和国为研究对象，对1999 - 2009年分娩住院情况进行回顾性队列研究。使用出院记录中的10-AM诊断代码识别PPH病例。使用Cochrane-Armitage趋势检验确定PPH发生率的显著时间趋势。采用对数二项回归分析评估PPH诊断风险的年度变化，并对潜在的混杂因素进行调整。主要结局指标为PPH、子宫收缩乏力、输血和病态粘连胎盘。结果共记录了649019例分娩住院; 2.6%（n = 16909）包括PPH诊断。总体PPH率从1999年的1.5%上升到2009年的4.1%;张力不足PPH从1999年的1.0%上升到2009年的3.4%。在阴道分娩、器械分娩、急诊和择期剖腹产中，观察到张力不足性PPH发生率呈显著增加趋势（P < 0.001）。失张力性PPH合并输血的发生率也显著增加（P < 0.001）。与1999年相比，2009年失张力性PPH的风险增加了3倍（调整后的RR 3.03; 95% CI 2.76-3.34）。诊断为病态粘连胎盘的妇女发生PPH的风险明显较高（未调整的RR 13.14; 95%CI 11.43-15.11）。结论张力缺乏性PPH的发病率增加，迫切需要研究和临床审计，重点是病因学因素，预防措施和护理质量，以指导当前的临床实践。
Objective To derive nationally representative incidence rates of postpartum haemorrhage (PPH), and to investigate trends associated with method of delivery, blood transfusion and morbidly adherent placenta (accreta, percreta and increta).Design Population-based retrospective cohort study.Setting Republic of Ireland.Population Childbirth hospitalisations during the period 19992009.Methods International Classification of Diseases (ICD)-9-CM and ICD-10-AM diagnostic codes from hospital discharge records were used to identify cases of PPH. Significant temporal trends in PPH incidence were determined using Cochrane-Armitage tests for trend. Log-binomial regression was conducted to assess annual changes in the risk of PPH diagnosis, with adjustment for potential confounding factors.Main outcome measures PPH, uterine atony, blood transfusion and morbidly adherent placenta.Results A total of 649 019 childbirth hospitalisations were recorded; 2.6% (n = 16 909) included a diagnosis of PPH. The overall PPH rate increased from 1.5% in 1999 to 4.1% in 2009; atonic PPH rose from 1.0% in 1999 to 3.4% in 2009. Significant increasing trends in atonic PPH rates were observed across vaginal, instrumental, and emergency and elective caesarean deliveries (P < 0.001). The rate of atonic PPH co-diagnosed with blood transfusion also significantly increased (P < 0.001). Relative to 1999, the risk of atonic PPH in 2009 was three-fold increased (adjusted RR 3.03; 95% CI 2.76-3.34). Women diagnosed with a morbidly adherent placenta had a markedly higher risk of total PPH (unadjusted RR 13.14; 95% CI 11.43-15.11).Conclusions Increasing rates of atonic PPH highlight the pressing need for research and for clinical audit focusing on aetiological factors, preventative measures and quality of care, to guide current clinical practice.