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首页> 外文期刊>American Journal of Obstetrics and Gynecology >Patterns of recurrence of postpartum hemorrhage in a large population-based cohort
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Patterns of recurrence of postpartum hemorrhage in a large population-based cohort

机译：大型人群队列中产后出血的复发模式

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Objective Although a history of postpartum hemorrhage (PPH) is a recognized risk factor for PPH in subsequent pregnancies, little is known about how the risk accumulates over multiple pregnancies, how recurrence varies by PPH subtype, and whether recurrence can be explained by chronic maternal conditions. Study Design Risks of PPH were assessed according to a history of PPH, severity, and subtype (atony, retained placenta, or lacerations) in 538,332 primiparous women whose data were included in the Swedish Medical Birth Register from 1997-2009. The role of stable maternal risk factors was evaluated in regression models that predicted probability of recurrent PPH in second and third pregnancy. Results Women with a history of PPH had a 3-fold increased risk of PPH in their second pregnancy compared with unaffected women (15.0% vs 5.0%, respectively). Adjustment for stable maternal risk factors did not attenuate this risk significantly (adjusted relative risk, 3.0; 95% confidence interval, 2.9-3.1). In a third pregnancy, the risk of PPH was 26.6% after 2 previously affected pregnancies, compared with 4.4% in women with no previous PPH. A history of a specific type of PPH predicted recurrence of PPH in the second pregnancy, not only of the same type but other causes as well. Conclusion PPH risk is highest among women with >1 previously affected delivery and in those with a previous severe PPH. Chronic conditions that are known to be risk factors for PPH do not explain the recurrence risks. The recurrence patterns across PPH subtypes may point to shared pathologic mechanisms underlying the varying PPH causes.
机译：目的尽管产后出血史（PPH）是继发妊娠的公认的PPH危险因素，但对于多次妊娠的风险如何累积，PPH亚型的复发如何变化以及是否可以由慢性孕产妇状况来解释，鲜为人知。根据PPH的病史，严重程度和亚型（无力，胎盘残留或撕裂伤），对538,332例初产妇女的PPH研究风险进行了评估，这些妇女的数据被纳入1997-2009年的瑞典医疗出生登记册。在回归模型中评估了稳定的孕产妇危险因素的作用，该模型预测了第二次和第三次妊娠再发PPH的可能性。结果有PPH病史的妇女在第二次妊娠中与未患病的妇女相比，PPH风险增加了3倍（分别为15.0％和5.0％）。调整稳定的孕产妇危险因素并不能显着降低该风险（调整后的相对风险为3.0; 95％的置信区间为2.9-3.1）。在第三次妊娠中，有2例先前受过怀孕的孕妇发生PPH的风险为26.6％，而以前无PPH的妇女为4.4％。一种特定类型的PPH的病史可预测第二次妊娠中PPH的复发，不仅是同一类型，还包括其他原因。结论以前> 1的孕妇分娩和以前有严重PPH的妇女中PPH风险最高。已知是PPH的危险因素的慢性病不能解​​释复发风险。 PPH亚型的复发模式可能指向各种PPH病因的共同病理机制。

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