Patterns and predictors of severe postpartum anemia after Cesarean section
Patterns and predictors of severe postpartum anemia after Cesarean section
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DOI：
10.1111/trf.13815
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发表时间：
2017-01-01
期刊：
影响因子：
2.9
通讯作者：
Escobar, Gabriel J.
中科院分区：
文献类型：
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作者：
Butwick, Alexander J.;Walsh, Eileen M.;Escobar, Gabriel J.
背景：产后贫血与孕产妇和围产期发病率相关。人口水平的数据可以为产后贫血筛查指南的制定提供信息。我们的目的是评估潜在的预测因素（产前贫血和产后出血[PPH]）与剖宫产术后严重产后贫血之间的关系。研究设计和方法：收集2005年至2013年期间在凯撒医疗北加州医院接受剖宫产手术的70,939例住院患者的数据。重度产后贫血定义为出院前血红蛋白（Hb）水平低于8 g/dL。使用多变量logistic回归，我们评估了产前贫血和PPH与产后严重贫血之间的关系。评估这些特征在产后严重贫血妇女中的分布。结果：总体重度产后贫血发生率为7.3%（95%可信区间[CI]， 7.1% ~ 7.4%）。产后严重贫血与产前Hb水平在10 - 10.9 g/dL之间（校正优势比[aOR]， 5.4; 95% CI, 4.89-5.91）、产前Hb水平小于10 g/dL （aOR, 30.6; 95% CI, 27.21-34.6）和PPH （aOR, 8.45; 95% CI, 7.8-9.16）密切相关。发生PPH但未发生产前贫血的妇女（12.2%;95% CI, 11.0%-13.6%）和未发生PPH但未发生产前贫血的妇女（10.7%;95% CI, 9.6%-12.0%）患严重产后贫血的妇女比例最高。结论：我们的研究结果提示PPH和产前贫血是严重产后贫血的独立危险因素。优化患者产前Hb可降低剖宫产术后严重贫血的发生率。
BACKGROUND: Postpartum anemia is associated with maternal and perinatal morbidity. Population-level data may inform guideline development for postpartum anemia screening. Our objectives were to evaluate the associations between potential predictors (predelivery anemia and postpartum hemorrhage [PPH]) with severe postpartum anemia after Cesarean section.STUDY DESIGN AND METHODS: Data were collected from 70,939 hospitalizations for Cesarean section performed at Kaiser Permanente Northern California facilities between 2005 and 2013. Severe postpartum anemia was defined as a hemoglobin (Hb) level of less than 8 g/dL before hospital discharge. Using multivariable logistic regression, we assessed the associations between predelivery anemia and PPH with severe postpartum anemia. Distributions of these characteristics among women with severe postpartum anemia were evaluated.RESULTS: The overall rate of severe postpartum anemia was 7.3% (95% confidence interval [CI], 7.1%-7.4%). Severe postpartum anemia was strongly associated with a predelivery Hb level between 10 and 10.9 g/dL (adjusted odds ratio [aOR], 5.4; 95% CI, 4.89-5.91), predelivery Hb level of less than 10 g/dL (aOR, 30.6; 95% CI, 27.21-34.6), and PPH (aOR, 8.45; 95% CI, 7.8-9.16). The proportions of women with severe postpartum anemia were highest for those experiencing PPH but no predelivery anemia (12.2%; 95% CI, 11.0%-13.6%) and those who did not incur PPH nor predelivery anemia (10.7%; 95% CI, 9.6%-12.0%).CONCLUSIONS: Our findings suggest that PPH and predelivery anemia are strong independent risk factors for severe postpartum anemia. Optimization of patients' Hb before delivery may reduce the incidence of severe anemia after Cesarean section.