Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines
Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines
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DOI：
10.1016/j.ajog.2015.02.023
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发表时间：
2015-07-01
影响因子：
9.8
通讯作者：
Rouse, Dwight J.
中科院分区：
文献类型：
--
作者：
Dahlke, Joshua D.;Mendez-Figueroa, Hector;Rouse, Dwight J.
目的：本研究的目的是比较4个国家产后出血（PPH）的预防和管理指南。研究设计：我们对美国妇产科医师学会实践公报、皇家和新西兰妇产科医师学会、皇家妇产科医师学会（RCOG）、和加拿大妇产科医师协会对PPH的定义，危险因素，预防，治疗和复苏，以确定差异，如果有的话，在所有4个指南中PPH的定义不同。指南中强调的风险因素赋予灾难性出血的高风险（例如，既往剖宫产和前置胎盘）。除美国妇产科医师学会外，所有组织都建议在所有阴道分娩中积极管理第三产程以预防PPH。催产素被普遍推荐为预防阴道分娩PPH的首选药物。澳大利亚皇家和新西兰妇产科医师学院和RCOG建议制定一项大规模输血方案来管理PPH复苏。非手术治疗策略的建议，如子宫填塞和球囊填塞在所有指南中各不相同。所有组织都建议转移到三级护理机构怀疑异常胎盘。子宫切除术的具体指征是没有在任何指南，RCOG建议子宫切除术“宜早不宜迟”的协助下，第二consultant.CONCLUSION：实质性的变化存在于PPH预防和管理指南之间的4个国家组织，强调需要更好的证据和更一致的合成现有的证据方面的主要原因产妇死亡。
OBJECTIVE: The purpose of this study was to compare 4 national guidelines for the prevention and management of postpartum hemorrhage (PPH).STUDY DESIGN: We performed a descriptive analysis of guidelines from the American College of Obstetrician and Gynecologists practice bulletin, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal College of Obstetrician and Gynaecologists (RCOG), and the Society of Obstetricians and Gynaecologists of Canada on PPH to determine differences, if any, with regard to definitions, risk factors, prevention, treatment, and resuscitation.RESULTS: PPH was defined differently in all 4 guidelines. Risk factors that were emphasized in the guidelines conferred a high risk of catastrophic bleeding (eg, previous cesarean delivery and placenta previa). All organizations, except the American College of Obstetrician and Gynecologists, recommended active management of the third stage of labor for primary prevention of PPH in all vaginal deliveries. Oxytocin was recommended universally as the medication of choice for PPH prevention in vaginal deliveries. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and RCOG recommended development of a massive transfusion protocol to manage PPH resuscitation. Recommendations for nonsurgical treatment strategies such as uterine packing and balloon tamponade varied across all guidelines. All organizations recommended transfer to a tertiary care facility for suspicion of abnormal placentation. Specific indications for hysterectomy were not available in any guideline, with RCOG recommending hysterectomy "sooner rather than later" with the assistance of a second consultant.CONCLUSION: Substantial variation exists in PPH prevention and management guidelines among 4 national organizations that highlights the need for better evidence and more consistent synthesis of the available evidence with regard to a leading cause of maternal death.