| Objectve:1. To review the risk factors of postpartum hemorrhage worldwide by use of evidence-based medicine.2. To explore the risk factors of postpartum hemorrhage happened in a maternity and child-care hospital in Gansu province through retrospective case-control study.3. Based on the results of the Meta analysis and the case-control study, an intervention strategy for postpartum hemorrhage in the course of pregestation, pregnancy and intrapartum was suggested focus on the main risk factors.Methods:1. Meta analysis on risk factors of postpartum hemorrhageThe risk factors of postpartum hemorrhage were reviewed by using Meta analysis and analysed by Stata 12.0. After generally collecting literatures published domestic and overseas of case-control and cohort studies in EMbase, PubMed, the Cochrane Library, Web of Science, VIP, WanFang Data, CBM and CNKI from the establishment of above databases to January 2015. The risk factors of postpartum hemorrhage included demography, psychology, history of pregnance and baby birth, antenatal care and some factors in perinatal period. The combined-OR and its 95% confidence interval were suitable to count data, and the SMD and its 95% confidence interval were used for continuous data.2. The results of case-control study concerning risk factors of postpartum hemorrhage by using cases in a maternity and child-care hospital in Gansu province150 cases of patients with postpartum hemorrhage and 150 puerperas without postpartum hemorrhage were selected in a maternity and child-care hospital in Gansu province. The ratio of patient and control is 1:1 taking age as a match factor. Each puerpera both in patient group and control group gave their childbirth through vaginal birth, and underwent the prenatal care and childbirth in the hospital from January 1st 2014 to December 31th 2014. A self-made questionnaire was used in this part of study with the contents of some common risk factors of postpartum hemorrhage and some new interventions which included the duration of third stage of childbirth, the duration of urinary retention, the duration of oxytocin intervention in the fist stage, water delivery and so on.The methods of univariate analysis and multivariate logistic regression were performed to explore the risk factors of postpartum hemorrhage by SAS 9.2 so as to explore the relationship between new interventions and the incidence of postpartum hemorrhage, and to provide suggestions for prevention and control of postpartum hemorrhage.Results:1. The results of Meta analysis71 literatures were selected for Meta analysis based on our including and excluding standards including 46 papers in Chinese and 25 in English; 16 were cohort studies and 55 were case-control studies.There was only one risk factor whch highly correlated with postpartum hemorrhage:uterine inertia 13.19 (7.9,22.03); 14 risk factors obviously correlated with postpartum hemorrhage: platelet abnormalities 8.40 (5.20,13.59), retained placenta 7.38 (1.41,13.35), placenta accreta or implants 6.78 (4.47,9.09), adverse psychological and emotion 6.29 (2.44,10.14), placenta previa 5.74 (3.14,8.08), placental abruption 5.01 (2.65,7.38), abortion≥34.78 (2.80,8.18), history of postpartum hemorrhage 2.20 (1.60,2.80), multiple pregnancies 2.51 (1.90,3.12), instrumental delivery 2.33 (1.98,2.74), abortion≥22.26 (1.90,2.63), labor≥22.24 (1.55,3.23), history of hemorrhage during pregnancy 2.20 (1.15,3.25), genital tract laceration 2.15 (1.62,2.87), labor≥3 2.14 (1.35,3.88), cesarean 2.13 (1.57,2.69); There were three risk factors which might correlate with postpartum hemorrhage:History of infertility 1.94 (1.13,2.76), baby weight≥4Kg 1.91 (1.62,2.19), age of pregnant woman≥351.36 (1.14,12.34);Some protective factors of postpartum hemorrhage were also found as follows:education status 0.28 (0.08,0.98), prenatal care 0.45 (0.24,0.84). In addition, prenatal BMI 0.42 (0.28,0.56), prenatal weight 0.24 (0.13,0.35), uterus height 0.49 (0.31,0.67) showed positive correlation with postpartum hemorrhage.2. The results of case-control studyUnivariate analysis showed that following risk factors were associated with postpartum hemorrhage with significant differences such as the time to get the first prenatal care, multiple pregnancies, placenta previa, episiotomy and laceration, duration of the third stage of delivery, education status, times of prenatal care in first trimester of pregnancy, times of prenatal care in second trimester of pregnancy, times of prenatal care in third trimester, uterine inertia and urinary retention.Taking the variables which showed significant differences into multivariate logistic regression model, the results were displayed as following:first time of prenatal care (OR 4.98, 95%CI 1.04-23.71), the third stage of delivery (OR 1.97,95%CI 1.55-7.05), uterine inertia (OR 2.19,95%CI 1.51-8.92), laceration (OR 1.70,95%CI 1.08-12.20), placenta previa (OR 6.12, 95% CI 3.52-70.91), urinary retention (OR 1.26,95%CI 1.13-10.53).Some protective factors were listed as following:education status (OR 0.120,95% CI 0.02-0.82), times of prenatal care in second trimester of pregnancy (OR 0.811,95%CI 0.50-0.84), times of prenatal care in third trimester of pregnancy (OR 0.42,95% CI 0.05-0.85).Conclusions:1. Postpartum hemorrhage is a result of comprehensive insults induced by various factors. The risk factors for postpartum hemorrhage inlude uterine inertia, platelet abnormalities, retained placenta, placenta accreta or implants, adverse psychological and emotion, placenta previa, placental abruption, abortion≥3, Past history of postpartum hemorrhage, multiple pregnancies, Instrumental delivery, abortion≥2, History of bleeding during pregnancy, genital tract laceration, cesarean, history of infertility,baby weight≥4Kg, age of pregnant woman≥35. The protective factors include education and prenatal care, prenatal BMI, prenatal weight and uterus height are positive correlation with postpartum hemorrhage.2. The results of multivariate logistic regression model suggest that the leading three risk factors were placenta previa, laceration and uterine inertia, at the same time we should pay attention to some new risk factors such as the third stage of labor, first time of prenatal care and urinary retention. On the other hand, education status, times of prenatal care in second and third trimester of pregnancy are the protective factors for postpartum hemorrhage.3. According to the results of evidence-based study and case-control study, we should take a comprehensive strategy to prevent and control postpartum hemorrhage including health education in prenatal, pregnancy and intrapartum, clinic intervention and prevention of retention of urine so as to prevent the occurrence of postpartum hemorrhage. |
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