Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort
Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort
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DOI：
10.1186/s12884-020-02971-3
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发表时间：
2020-05-06
影响因子：
3.1
通讯作者：
Collins, Peter W.
中科院分区：
文献类型：
--
作者：
Bell, Sarah F.;Watkins, Adam;Collins, Peter W.
背景分娩后目测失血量往往低估实际出血量。为了提高准确性，威尔士12家提供产科护理的医院对所有分娩都采用了定量失血测量。这项干预措施被纳入了一项质量改进方案（威尔士产科出血战略，OBS Cymru）。我们报告产后出血的发病率在威尔士超过1年的时间使用quantitative measurement.MethodsThis前瞻性的，连续的队列包括所有31，341名妇女在威尔士分娩在2017年。威尔士所有12家医院的产科工作人员都接受了标准化培训。培训包括模拟场景、视频和团队演练。在每个中心稽查定量失血测量的摄取。收集产后出血> 1000 mL的数据，并根据分娩方式进行分析。所有产妇的失血数据来自NHS威尔士信息服务。结果半年审计数据显示，定量测量从52.1%增加到87.8%，（P 1000 mL、> 1500 mL和> 2000 mL分别为8.6%（8.3至8.9）、3.3%（3.1至3.5）和1.3%（1.2至1.4），而OBS Cymru前一年为5%、2%和0.8%。尽管12家医院的规模、人员配备水平和病例组合差异很大，但> 1000 mL出血的发生率（95% CI）相似，中位数（第25至第75百分位数）为8.6%（7.8-9.6）。PPH的发生率因分娩方式而异，平均（95%CI）为4.9%（4.6-5.2）无辅助阴道分娩，18.4（17.1-19.8）对于阴道助产，8.5（7.7-9.4）择期剖腹产和19.8（18.6-21.0）为非择期剖腹产。ConclusionsQuantitative测量失血量是可行的，在所有医院提供产妇保健，并与检测率较高的产后出血。这些结果对分娩后异常失血的定义以及产后出血的管理和研究具有意义。
BackgroundVisual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru). We report the incidence of postpartum haemorrhage in Wales over a 1-year period using quantitative measurement.MethodsThis prospective, consecutive cohort included all 31,341 women giving birth in Wales in 2017. Standardised training was cascaded to maternity staff in all 12 hospitals in Wales. The training comprised mock-scenarios, a video and team drills. Uptake of quantitative blood loss measurement was audited at each centre. Data on postpartum haemorrhage of >1000mL were collected and analysed according to mode of delivery. Data on blood loss for all maternities was from the NHS Wales Informatics Service.ResultsBiannual audit data demonstrated an increase in quantitative measurement from 52.1 to 87.8% (P1000mL, >1500mL and>2000mL was 8.6% (8.3 to 8.9), 3.3% (3.1 to 3.5) and 1.3% (1.2 to 1.4), respectively compared to 5%, 2% and 0.8% in the year before OBS Cymru. The incidence (95% CI) of bleeds of >1000mL was similar across the 12 hospitals despite widely varied size, staffing levels and case mix, median (25th to 75th centile) 8.6% (7.8-9.6). The incidence of PPH varied with mode of delivery and was mean (95% CI) 4.9% (4.6-5.2) for unassisted vaginal deliveries, 18.4 (17.1-19.8) for instrumental vaginal deliveries, 8.5 (7.7-9.4) for elective caesarean section and 19.8 (18.6-21.0) for non-elective caesarean sections.ConclusionsQuantitative measurement of blood loss is feasible in all hospitals providing maternity care and is associated with detection of higher rates of postpartum haemorrhage. These results have implications for the definition of abnormal blood loss after childbirth and for management and research of postpartum haemorrhage.