Risk Factors for Atonic Postpartum Hemorrhage: A Systematic Review and Meta-analysis.
Risk Factors for Atonic Postpartum Hemorrhage: A Systematic Review and Meta-analysis.
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DOI：
10.1097/aog.0000000000004228
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发表时间：
2021-02-01
影响因子：
7.2
通讯作者：
Bauchat JR
中科院分区：
文献类型：
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作者：
Ende HB;Lozada MJ;Chestnut DH;Osmundson SS;Walden RL;Shotwell MS;Bauchat JR
确定和量化失张力性产后出血的危险因素。在PubMed、CINAHL、EMBASE、Web of Science和ClinicalTrials.gov数据库中检索英语语言研究，不限制日期或地点。研究包括随机试验，前瞻性或回顾性队列研究，以及对发生失张力性产后出血并报告至少一种风险因素的妊娠患者的病例对照研究。使用Raayan网络应用程序进行标题、摘要和全文筛选。在筛选的1，239份记录中，27项研究被纳入本综述。记录或计算校正或未校正的比值比（OR）、相对风险或率比。对于每个风险因素，低和中度偏倚风险研究的定性综合将风险因素分类为明确、可能、不明确或不是风险因素。对于定义和参考范围足够均匀的风险因素，对低和中度偏倚风险研究进行定量荟萃分析，以估计合并OR。本综述确定了47个失张力性产后出血的潜在危险因素，其中15个被判定为明确或可能的危险因素。其余32个评估的风险因素显示与张力不足性产后出血无关，或有相互矛盾或不明确的证据。很大一部分产后出血发生在没有公认的危险因素的情况下。目前的风险评估工具中包含了许多张力不足性出血的风险因素，其中任何病因的既往产后出血、前置胎盘、胎盘脱垂、子宫破裂和多胎妊娠的风险最大。目前未纳入风险评估工具的新风险因素包括高血压、糖尿病和种族。在本综述中，肥胖和镁与失张力性产后出血无关。PROSPERO，CRD 42020157521。
To identify and quantify risk factors for atonic postpartum hemorrhage. PubMed, CINAHL, EMBASE, Web of Science, and and ClinicalTrials.gov databases were searched for English language studies with no restrictions on date or location. Studies included randomized trials, prospective or retrospective cohort studies, and case–control studies of pregnant patients who developed atonic postpartum hemorrhage and reported at least one risk factor. Title, abstract, and full-text screening were performed using the Raayan web application. Of 1,239 records screened, 27 studies were included in this review. Adjusted or unadjusted odds ratios (ORs), relative risks, or rate ratios were recorded or calculated. For each risk factor, a qualitative synthesis of low and moderate risk of bias studies classifies the risk factor as definite, likely, unclear, or not a risk factor. For risk factors with sufficiently homogeneous definitions and reference ranges, a quantitative meta-analysis of low and moderate risk of bias studies was implemented to estimate a combined OR. Forty-seven potential risk factors for atonic postpartum hemorrhage were identified in this review, of which 15 were judged definite or likely risk factors. The remaining 32 assessed risk factors showed no association with atonic postpartum hemorrhage or had conflicting or unclear evidence. A substantial proportion of postpartum hemorrhage occurs in the absence of recognized risk factors. Many risk factors for atonic hemorrhage included in current risk-assessment tools were confirmed, with the greatest risk conferred by prior postpartum hemorrhage of any etiology, placenta previa, placental abruption, uterine rupture, and multiple gestation. Novel risk factors not currently included in risk-assessment tools included hypertension, diabetes, and ethnicity. Obesity and magnesium were not associated with atonic postpartum hemorrhage in this review. PROSPERO, CRD42020157521.