产后出血的原因和危险因素:系统审查和元分析
Idnan Yunas1, Md Asiful Islam2, Kulandaipalayam N Sindhu1
1Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham, UK.
Lancet (London, England)
|April 6, 2025
概括
产后出血 (PPH) 最常见的原因是子宫缩. 识别贫血和以前的PPH等危险因素可以帮助针对这种常见的分娩并发症进行干预.
科学领域:
- 产科和妇科
- 公共卫生
- 流行病学
背景情况:
- 产后出血 (PPH) 是全球孕产妇死亡的一个重要原因.
- 了解PPH的原因和风险因素对于有效的预防和管理至关重要.
- 这项研究解决了对PPH病因和相关风险因素的综合数据的需求.
研究的目的:
- 系统地审查和分析产后出血的原因和危险因素.
- 量化PPH原因和相关风险因素的汇总率.
- 为预防和治疗PPH提供临床实践和公共卫生策略.
主要方法:
- 从1960年到2024年,对多个数据库进行系统的文献搜索 (MEDLINE,Embase,科学网,Cochrane图书馆,谷歌学者).
- 包括以人口为基础的英语队列研究,至少有两位作者进行独立的数据提取和质量评估.
- 使用随机效应模型进行元分析,将PPH原因和风险因子的概率比率 (ORs) 结合起来,将关联分为弱,中等或强.
主要成果:
- 综合了327项涉及847万女性的研究数据.
- 子宫衰竭是最常见的原因 (70.6%),其次是生殖器外伤 (16. 9%) 和保留的胎盘 (16. 4%).
- 强烈的危险因素包括贫血,先前的PPH,剖腹产和败血症;中度的危险因素包括肥胖和子宫前;弱弱的危险因素包括某些族裔和引发分娩.
结论:
- 子宫是PPH的主要原因,支持预防性子宫.
- 鉴定具有强烈风险因素的妇女可以提高针对性的预防和治疗.
- 多种PPH原因的频繁发生凸显了治疗捆绑的实用性.
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