Postpartum Hemorrhage Trends and Outcomes in the United States, 2000-2019
Postpartum Hemorrhage Trends and Outcomes in the United States, 2000-2019
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DOI：
10.1097/aog.0000000000004972
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发表时间：
2023-01-01
影响因子：
7.2
通讯作者：
Wen, Timothy
中科院分区：
文献类型：
--
作者：
Corbetta-Rastelli, Chiara M.;Friedman, Alexander M.;Wen, Timothy
目的：分析产后出血的时间趋势和危险因素，并分析危险因素与输血和围产期子宫切除术等产后出血相关干预措施的关联。 方法：这项重复横断面研究分析了 2000 年至 2019 年全国住院患者样本中的分娩住院情况。使用连接点回归进行趋势分析，以估计 95% CI 的平均年度百分比变化 (AAPC)。采用未经调整和调整的调查加权逻辑回归模型来评估产后出血危险因素与以下可能性之间的关系：1) 产后出血，2) 需要输血的产后出血，3) 产后出血情况下的围产期子宫切除术，以未调整的比值比和调整后的比值比（95% CI）作为相关性衡量标准。 7670 万人次分娩住院，其中 230 万人（3.0%）并发产后出血。 2000年至2019年，产后出血率从2.7%上升至4.3%（AAPC 2.6%，94% CI 1.7-3.5%）。在研究期间，具有至少一种产后出血危险因素的个体的分娩比例从 18.6% 增加至 26.9%（AAPC 1.9%，95% CI 1.7-2.0%）。在并发产后出血的分娩中，输血从 2000 年至 2011 年的 5.4% 增加至 16.7%，然后从 2011 年至 2019 年从 16.7% 下降至 12.6%。产后出血住院患者的围产期子宫切除术从 2000 年至 2019 年的 1.4% 增加至 2.4%。 2009年，2009年至2016年没有显着变化，然后从2016年至2019年从2.1%显着下降至0.9%（AAPC -27.0%，95% CI -35.2%至-17.6%）。与产后出血以及产后出血情况下的输血和子宫切除术相关的危险因素包括先前剖宫产且前置胎盘或植入胎盘、前置胎盘但未进行剖宫产以及产前出血或胎盘早剥。结论：产后出血和相关危险因素在 20 年内增加。尽管产后出血率有所增加，但近年来输血和子宫切除率却有所下降。
OBJECTIVE:To analyze temporal trends in and risk factors for postpartum hemorrhage and to analyze the association of risk factors with postpartum hemorrhage-related interventions such as blood transfusion and peripartum hysterectomy.METHODS:This repeated cross-sectional study analyzed delivery hospitalizations from 2000 to 2019 in the National (Nationwide) Inpatient Sample. Trends analyses were conducted using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Unadjusted and adjusted survey-weighted logistic regression models were performed to evaluate the relationship between postpartum hemorrhage risk factors and likelihood of 1) postpartum hemorrhage, 2) postpartum hemorrhage that requires blood transfusion, and 3) peripartum hysterectomy in the setting of postpartum hemorrhage, with unadjusted odds ratios and adjusted odds ratios with 95% CIs as measures of association.RESULTS:Of an estimated 76.7 million delivery hospitalizations, 2.3 million (3.0%) were complicated by postpartum hemorrhage. From 2000 to 2019, the rate of postpartum hemorrhage increased from 2.7% to 4.3% (AAPC 2.6%, 94% CI 1.7-3.5%). Over the study period, the proportion of deliveries to individuals with at least one postpartum hemorrhage risk factor increased from 18.6% to 26.9% (AAPC 1.9%, 95% CI 1.7-2.0%). Among deliveries complicated by postpartum hemorrhage, blood transfusions increased from 5.4% to 16.7% from 2000 to 2011 and then decreased from 16.7% to 12.6% from 2011 to 2019. Peripartum hysterectomy among hospitalized individuals with postpartum hemorrhage increased from 1.4% to 2.4% from 2000 to 2009, did not change significantly from 2009 to 2016, and then decreased significantly from 2.1% to 0.9% from 2016 to 2019 (AAPC -27.0%, 95% CI -35.2% to -17.6%). Risk factors associated with postpartum hemorrhage and transfusion and hysterectomy in the setting of postpartum hemorrhage included prior cesarean delivery with previa or placenta accreta, placenta previa without prior cesarean delivery, and antepartum hemorrhage or placental abruption.CONCLUSION:Postpartum hemorrhage and related risk factors increased over a 20-year period. Despite the increased postpartum hemorrhage rates, blood transfusions, and hysterectomy rates decreased in recent years.