阴道分娩后难治性产后出血的孕产妇特征和病因：对WHO CHAMPION试验数据的次要分析
【目的】
评价难治性产后出血（postpartumhaemorrhage，PPH）孕产妇的特征和病因。
【设计】
对WHO CHAMPION试验数据的次要分析。
【处所】
10个国家23家医院。
【人群】
CHAMPION试验中以宫缩剂作为产后出血一线治疗的产妇。
【主要测量结局】
孕产妇特征；产后出血病因。
【方法】
我们评价社会人口学，妊娠和新生儿因素和难治性产后出血之间的关联。比较难治性PPH组和对PPH一线治疗有反应组产后出血的病因。
【结果】
校正试验中心和试验组多因素分析后，与参考组相比，用宫缩剂引产或加速产程（aOR 1.35；95%CI 1.07-1.72），会阴侧切或需要缝合的会阴阴道裂伤（aOR 1.82；95%CI 1.34-2.48），新生儿体重≥3500g（aOR 1.33；95%CI 1.04-1.69），这些产妇的难治性产后出血比值比显著升高。在对PPH治疗有反应组中，宫缩乏力作为单一产后出血病因占53.2%（116/218），而在难治性PPH组，宫缩乏力仅占31.5%(45/143)。相反地，会阴阴道撕裂作为单一产后出血病因在对PPH治疗有反应组中占12.8%（28/128），难治性PPH组中占28%（40/143）。胎盘因素作为单一产后出血病因，在对PPH治疗有反应组中占11%，难治性PPH组中占5.6%。
【结论】
与对PPH一线治疗有反应的产妇相比，难治性产后出血的产妇在孕产妇特征和病因方面显现出差异。
CHAMPION试验流程图
不同组别产后出血病因占比
Maternal characteristics andcauses Associated with refractory postpartumhaemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trialdata
MWidmer GPiaggio GJHofmeyr GCarroli ACoomarasamy IGallos SGoudar AMGülmezoglu SLLin PLumbiganon KMugerwa OOwa ZQureshi FAlthabe
First published:06 December 2019
https://doi.org/10.1111/1471-0528.16040
Trial Registration number: ACTRN12614000870651;EudraCT number 2014‐004445‐26.
【Objective】
To assess the maternal characteristics andcauses associated with refractory postpartum haemorrhage (PPH).
【Design】
Secondary analysis of the WHO CHAMPIONtrial data.
【Setting】
Twenty‐three hospitals in ten countries.
【Population】
Women from the CHAMPION trial who receiveduterotonics as first‐line treatment of PPH.
【Methods】
We assessed the association between sociodemographic,pregnancy and childbirth factors and refractory PPH, and compared the causes ofPPH between women with refractory PPH, and women responsive to first‐line PPHtreatment.
【Main outcome measures】
Maternal characteristics; causes of PPH.
【Results】
Women with labour induced or augmented withuterotonics [adjusted odds ratio (aOR) 1.35; 95% CI 1.07–1.72], with episiotomyor tears requiring suturing (aOR 1.82; 95% CI 1.34–2.48), and who had babieswith birthweights ≥3500 g (aOR 1.33; 95% CI 1.04–1.69), showedsignificantly higher odds of refractory PPH compared with the referencecategories in the multivariate analysis adjusted by centre and trial arm. Whileatony was the sole PPH cause in 53.2% (116/218) of the women in the responsivePPH group, it accounted for only 31.5% (45/143) of the causes in the refractoryPPH group. Conversely, tears were the sole cause in 12.8% (28/218) and 28%(40/143) of the responsive PPH and refractory PPH groups, respectively.Placental problems were the sole cause in 11 and 5.6% in the responsive andrefractory PPH groups, respectively.
【Conclusion】
Women with refractory PPH showed adifferent pattern of maternal characteristics and PPH causes compared withthose with first‐line treatment responsive PPH.
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（编译 王伟琳）
