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Effect of Cesarean Section on the Severity of postpartum hemorrhage in Chinese Women： The Shanxi Study

Current Medical Science 2018年第4期38卷 618-625页

作者： Chang XU Qiang FU Hong-bing TAO Xiao-jun LIN Man-li WANG Shu-xu XIA Hao-ling XIONG Department of Health Administration School of Medicine and Health Management Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China Department of Epidemiology and Biostatistics College for Public Health and Social Justice Saint Louis University Saint Louis 63104 USA

postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group.

关键词： postpartum hemorrhage cesarean section parity indications

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Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage:Focusing on difference in angiographic findings

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World Journal of Clinical Cases 2023年第15期11卷 3471-3480页

作者： Bong Man Kim Gyeong Sik Jeon Min Jeong Choi Nam-Soo Hong Department of Radiology Dankook University HospitalDankook University College of MedicineCheonan-si 31116Chungcheongnam-doSouth Korea Department of Radiology CHA Bundang Medical CenterCollege of MedicineCHA UniversitySeongnam-si 13496Gyeonggi-doSouth Korea Department of Preventive Medicine School of MedicineKyungpook National UniversityDaegu 41944South Korea

BACKGROUND Transcatheter arterial embolization(TAE)has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management,but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage(PPH).AIM To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic *** We conducted a research from January 2008 to July 2022 on all 83 patients(mean:32 years,range:24-43 years)presented with secondary PPH and they were treated with TAE in two university *** medical records and angiography were retrospective reviewed in order to evaluate the patients’characteristics,delivery details,clinical status and peri-embolization management,angiography and embolization details,technical/clinical success and *** group with active bleeding sign and the group without it were also compared and *** On angiography,46(55.4%)patients showed active bleeding signs such as contrast extravasation(n=37)or pseudoaneurysm(n=8)or both(n=1),and 37(44.6%)patients showed non-active bleeding signs such as only spastic uterine artery(n=2)or hyperemia(n=35).In the active bleeding sign group there were more multiparous patients,low platelet count,prothrombin time prolongation,and high transfusion *** technical success rates were 97.8%(45/46)in active bleeding sign group and 91.9%(34/37)in non-active bleeding sign group,and the overall clinical success rates were 95.7%(44/46)and 97.3%(36/37).An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization,therefore hysterostomy and retained placenta removal were performed which was a major *** TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.

关键词： postpartum hemorrhage Angiography Transcatheter arterial embolization Pseudoaneurysm Nbutylcyanoacrylate

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postpartum hemorrhage: Incidence, Causes and Maternal Outcomes at Muhimbili National Hospital, Tanzania—A Retrospective Descriptive Hospital-Based Study

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Open Journal of Obstetrics and Gynecology 2023年第7期13卷 1244-1258页

作者： Rafiki Nickson Mjema Amani Idris Kikula Furaha August Fadhlun Alwy Al-Beity Ali Said Phineas F. Sospeter Nasra Batchu Benjamin Shayo Damian Jeremiah Ponsian P. Kunambi John Somi Patricia Swai Department of Obstetrics and Gynecology Muhimbili University of Health and Allied Sciences MUHAS Dar es Salaam Tanzania Department of Reproductive Maternal and Child Health Ministry of Health Dodoma Tanzania Department of Obstetrics and Gynecology Kilimanjaro Christian Medical Centre Moshi Kilimanjaro Tanzania Department of Obstetrics and Gynecology Baylor’s College Lilongwe Malawi Kilimanjaro Christian Medical University College Moshi Kilimanjaro Tanzania

Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000 per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While rates of postpartum hemorrhage have continued to rise, there is a need to evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal outcomes of postpartum hemorrhage at Muhimbili National Hospital for a period of 7 years. Methodology: This is a retrospective descriptive hospital-based study that has included all cases of postpartum hemorrhage at Muhimbili National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of postpartum hemorrhage over time were determined using chi-square test and P-value where less than 0.05 was considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78% and maximum of 2.87% with no statistical significance. Out of 1113 enrolled cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically significant increase in linear trend was observed in the postpartum hemorrhage cases due to uterine atony, uterine rupture and sub analysis on genital tears (cervical tear). Overall, there was a statistically significant change in trend of maternal outcomes throughout the years, with a P-value postpartum hemorrhage has been fluctuating over the years during the

关键词： postpartum hemorrhage Incidence Causes Maternal Outcomes and Tanzania

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Quantifying the Accuracy of Clinician Risk Assessment for postpartum hemorrhage

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Maternal-Fetal Medicine 2024年第4期6卷 211-214页

作者： Ashley N.Lewis Diego Villela-Franyutti Henry J.Domenico Daniel W.Byrne Michaela K.Farber Holly B.Ende Department of Anesthesiology Vanderbilt University Medical CenterNashvilleTN 37232United States Department of Anesthesiology Perioperativeand Pain MedicineBrigham and Women’s HospitalBostonMA 02115United States Department of Biostatistics Vanderbilt University Medical CenterNashvilleTN 37232United States

Objective To measure the accuracy of postpartum hemorrhage(PPH)risk assessment performed by unaided individual clinicians,to inform future comparison to alternative risk assessment *** Prospective PPH risk assessments were collected from obstetric care team clinicians at two quaternary medical centers in the United States(Vanderbilt University Medical Center,Brigham and Women’s Hospital)from January 2022 to January 2023,following written informed consent from the *** data included a cohort of both vaginal and cesarean deliveries(CD).For each assessment,the clinician quantified the patient’s predicted PPH risk on a scale from 0 to 100%and rated their confidence in these assessments using a 5-point Likert scale,ranging from‘not at all confident’to‘completely confident’.Medical records were reviewed 24 hours postpartum to assess the dichotomous outcome of PPH,defined as blood loss≥1000 *** accuracy of these predictions was evaluated using the area under the receiver operating characteristic curve(AUC).Results Of 271 patients,32(11.8%)experienced PPH,accounting for 11.4%(104/915)of *** overall AUC was 0.64(95%confidence interval(CI):0.58–0.71).Prediction accuracy was higher for CD than for vaginal deliveries,with AUCs of 0.82(95%CI:0.72–0.91)and 0.56(95%CI:0.48–0.63),*** significant differences in the accuracy of assessments were observed according to physician specialty,physician experience level,or confidence level of the *** Overall unaided clinician performance in predicting PPH was moderate,with an AUC of *** were more accurate for patients undergoing *** study is needed to understand how clinician performance compares to other modalities of risk prediction.

关键词： postpartum hemorrhage Maternal morbidity Obstetrics Pregnancy Risk factors Risk prediction

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Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation(BHGAL)due to severe postpartum hemorrhage

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Asian pacific Journal of Reproduction 2024年第1期13卷 28-33页

作者： OKUTUCU Gulcan EVSEN Mehmet S PEKER Nurullah YAMAN TUNC Senem ICEN Mehmet S Department of Obstetrics and Gynecology Division of PerinatologyTurkish Ministry of Health Ankara City HospitalAnkaraTurkey Department of Obstetrics and Gynecology Dicle UniversitySchool of MedicineDiyarbakirTurkey

Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum ***:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the *** records of cases were obtained from the hospital database,*** demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were *** cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after *** was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were ***:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the *** of these cases(23%)were diagnosed with secondary *** fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three ***:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy *** is a tertiary center experience and cohort studies with large patient series are needed.

关键词： Fertility Iliac artery Ligations postpartum hemorrhage Pregnancy outcomes

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postpartum hemorrhage: A Technical Essay

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Open Journal of Nursing 2023年第8期13卷 583-599页

作者： Rita de Cássia Teixeira Rangel Eneida Patrícia Teixeira Maria de Lourdes de Souza Fiona Ann Lynn Rodrigo Massaroli Adália Edna Fernando Chipindo University of Vale do Itajai (UNIVALI) Itajaí Brazil Post Graduation Nursing Program (PEN) Federal University of Santa Catarina Florianópolis Brazil REPENSUL Institute Florianópolis Brazil Queen’s University Belfast (QUB) Belfast UK

Background: postpartum hemorrhage is one of the main causes of maternal mortality, mainly in underdeveloped countries. Deaths are mostly preventable, and are related to socioeconomic development, organization of health services and professional training. Objective: To systematize alerts for the prevention of postpartum hemorrhage. Method: This is a technical essay developed from reflections on previously produced and published texts about maternal mortality and has hemorrhage as the focus of this study. Results: It presents the concept, classification of hemorrhage, risk factors and their classification, prevention strategies, universal recommendations, pharmacological and non-pharmacological interventions when hemorrhage already exists, bleeding assessment techniques;clinical evaluation, by laboratory examination and by shock index. Conclusions: hemorrhage is a preventable cause of maternal death through the accomplishment of multiple care. Hospital care must be conducted by qualified professionals and in adequate numbers. The risk diagnosis must be carried out during prenatal care with the recording of clinical data accessible in the health care network. All references studied are not specific to nursing, as hemorrhage prevention requires multidisciplinary action.

关键词： postpartum hemorrhage Multiple Care Risk Diagnosis Prevention

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Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

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Frontiers of Nursing 2019年第4期6卷 285-291页

作者： Ying Liu Ya-Jing Fan Wei Zhuang Qun Huang Nursing Department The International Peace Maternity&Child Health HospitalShanghai Jiaotong University School of MedicineShanghai 200030China Nursing Department Shanghai 6th People’s Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghai 200233China Hospital Administration Department Shanghai First Maternity and Infant HospitalShanghai 201204China

Objective: postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical ***: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally ***: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of ***: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.

关键词： postpartum hemorrhage assessment intervention protocol evidence-based method modified Delphi technique

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Predicting risk of postpartum hemorrhage using machine learning approach:A systematic review

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Gynecology and Obstetrics Clinical Medicine 2023年第3期3卷 170-174页

作者： Amene Ranjbar Sepideh Rezaei Ghamsari Banafsheh Boujarzadeh Vahid Mehrnoush Fatemeh Darsareh Fertility and Infertility Research Center Hormozgan University of Medical SciencesBandar AbbasIran Department of Midwifery and Reproductive Health Tehran University of Medical SciencesTehranIran Mother and Child Welfare Research Center Hormozgan University of Medical SciencesBandar AbbasIran

Background postpartum hemorrhage(PPH)could be avoided by identifying high-risk *** objective of this systematic review is to determine PPH predictors using machine learning(ML)*** This strategy included searching for studies from inception through November 2022 through the database included:Cochrane Central Register,PubMed,MEDLINE,EMBASE,ProQuest,Scopus,WOS,IEEE Xplore,and the Google Scholar *** search methodology employed the PICO framework(population,intervention,control,and outcomes).In this study,“P”represents PPH populations,“I”represents the ML approach as intervention,“C”represents the traditional statistical analysis approach as control,and“O”represents prediction and diagnosis *** quality assessment of each included study was performed using the PROBAST *** The initial search strategy resulted in 2048 citations,which were subsequently refined by removing duplicates and irrelevant ***,four studies were deemed eligible for inclusion in the *** these studies,three were classified as having a low risk of bias,while one was considered to have a low to moderate risk of bias.A total of 549 unique variables were identified as candidate predictors from the included *** distinct models were chosen as ML algorithms from the four *** of the four studies employed different metrics,such as the area under the curve,false positive rate,false negative rate,and sensitivity,to report the accuracy of their *** ML models exhibited varying accuracies,with the area under the curve(AUC)ranging from 0.706 to *** weighted predictors were identified as significant factors in PPH risk *** included pre-pregnancy maternal weight,maternal weight at the time of admission,fetal macrosomia,gestational age,level of hematocrit at the time of admission,shock index,frequency of contractions during labor,white blood cell count,pregnancy-induced hypertension,the weight of

关键词： postpartum hemorrhage Risk factors Machine learning

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postpartum hemorrhage Following Cesarean Delivery in Women with a Scarred Uterus:A Retrospective Cohort Study

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Reproductive and Developmental Medicine 2019年第4期3卷 230-234页

作者： Bing-Nan Chen Di Wang Jia-Po Li Li-Yang Zhang Chong Qiao Department of Obstetrics and Gynaecology Shengjing Hospital of China Medical UniversityShenyang 110004China Key Laboratory of Maternal-Fetal Medicine China Medical UniversityShenyang 110004China Research Center of China Medical University Birth Cohort Shenyang 110004China

Objective:To develop a model to predict the risk of postpartum hemorrhage(PPH)following cesarean delivery in women with a scarred ***:A total of 4,637 pregnant women with scarred uterus who underwent a cesarean delivery at a large hospital between January 2014 and December 2017 were *** women were divided into PPH(n=287)and non-PPH(n=4,350)groups.A model to predict PPH(blood loss≥1,000 mL within 24 h following cesarean delivery)was developed using multivariate logistic regression *** operating characteristic curve was drawn,and the area under curve(AUC)was ***:The incidence of PPH was 6.19%(287 of 4,637 women).Seven independent risk factors were associated with PPH:maternal age(odds ratio[OR]=1.42,95%confidence interval[CI]:1.02-1.97),previous gravidity(OR=1.24,95%CI:1.01-1.50),placental location(posterior wall of uterus,OR=0.69,95%CI:0.47-1.02;other locations,OR=1.21,95%CI:0.81-1.80),placenta previa(incomplete placenta previa,OR=10.51,95%CI:5.99-18.42;complete placenta previa,OR=31.65,95%CI:21.07-47.54),placenta accreta(OR=6.39,95%CI:4.02-10.16),hypertensive disorders of pregnancy(OR=2.27,95%CI:1.40-3.68),and fetal position(breech position,OR=2.07,95%CI:1.19-3.60;transverse position,OR=1.07,95%CI:0.48-2.41).A predictive model with AUC of 0.89 was developed(95%CI:0.86-0.91,P<0.001).Conclusions:A model was developed to predict PPH following cesarean delivery in women with a scarred uterus.

关键词： Cesarean Delivery Logistic Regression postpartum hemorrhage Prediction Risk Factors

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Low-dose aspirin in the prevention of pre-eclampsia in China: postpartum hemorrhage in subgroups of women according to their characteristics and potential bleeding risk

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Chinese Medical Journal 2023年第5期136卷 550-555页

作者： Jiahui Chen Jing Huai Li Lin Boya Li Yuchun Zhu Huixia Yang Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus Beijing 100034China.

Background:The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for *** was no statistically significant difference in postpartum hemorrhage(PPH)incidence between the aspirin and control *** study aimed to evaluate the potential bleeding risk of 100 mg aspirin in high-risk pregnant women and the difference in the incidence of PPH according to maternal ***:This is a secondary data analysis of the APPEC *** counts and coagulation test results were collected at five follow-up *** defined by maternal age(<35 years and≥35 years),pre-pregnancy body mass index(pre-BMI,<28 kg/m 2 and≥28 kg/m 2),parity,gestational age at enrollment,and medical history,including pre-eclampsia,chronic hypertension,and diabetes mellitus,were *** regression analysis was used to determine the statistical significance of the difference in the incidence of PPH after aspirin administration in pregnant women in each *** using multiple logistic regression models followed these *** logistic regression was used to determine the relationship between pre-BMI and ***:There was no significant difference between the aspirin and control groups in bleeding risk(3.4%[16/464]vs.3.0%[13/434],T=0.147,P=0.701).No significant difference was found in the incidence of PPH in total(relative risk=1.220,95%confidence interval[CI]=0.720–2.067,P=0.459;aspirin group *** group,6.5%[30/464]vs.5.3%[23/434],P=0.459)or in subgroup analysis.A significant correlation between pre-BMI and PPH was found in the aspirin group,while in the control group there was no significant correlation(aspirin group,odds ratio[OR]=1.086,95%CI=1.004–1.175,P=0.040;control group,OR=1.060,95%CI=0.968–1.161,P=0.209).Conclusions:A dosage of 100 mg of aspirin per day,initiated from 12 to 20 gestational weeks until 34 weeks of gestation,did not increa

关键词： APPEC study Aspirin postpartum hemorrhage Body mass index Pre-eclampsia

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