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中华妇幼临床医学杂志(电子版) ›› 2024, Vol. 20 ›› Issue (05) : 498 -503. doi: 10.3877/cma.j.issn.1673-5250.2024.05.004

产科前沿专辑

产后出血风险评估和早期预警系统
李霞林1, 贺芳1,()   
  1. 1.广州医科大学附属第三医院妇产科,广东省产科重大疾病重点实验室,广东省妇产疾病临床医学研究中心,粤港澳母胎医学高校联合实验室,广州 510150
  • 收稿日期:2024-08-03 修回日期:2024-09-18 出版日期:2024-10-01
  • 通信作者: 贺芳
  • 基金资助:
    国家重点研发计划重点专项项目(2021YFC2701500)

Risk assessment and early warning system for postpartum hemorrhage

Xialin Li1, Fang He1,()   

  1. 1.Department of Obstetrics and Gynecology,Key Laboratory for Major Obstetric Diseases of Guangdong Province,Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology,Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,Guangdong Province,China
  • Received:2024-08-03 Revised:2024-09-18 Published:2024-10-01
  • Corresponding author: Fang He
引用本文:

李霞林, 贺芳. 产后出血风险评估和早期预警系统[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 498-503.

Xialin Li, Fang He. Risk assessment and early warning system for postpartum hemorrhage[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 498-503.

产后出血(PPH)是分娩期严重并发症之一,是导致孕产妇死亡的首要原因。提前识别并量化PPH 风险,对于指导产科临床实践,对孕产妇及时采取预防和治疗措施,降低因PPH 所致严重并发症发生率具有重要意义。笔者拟就PPH 定义及危险因素与PPH 主要风险评估工具、数值模拟模型及早期预警系统(EWS)的临床应用现状与临床意义进行阐述,旨在为我国PPH 临床管理提供适当帮助。

Postpartum hemorrhage(PPH)is one of the most severe complications during childbirth and the leading cause of maternal mortality.Early identification and quantification of PPH risk are critical for guiding obstetric clinical practice,enabling timely preventive and therapeutic interventions,and reducing severe complications associated with PPH.This article aims to elaborate on the latest research status of PPH definitions and risk factors,and the clinical application and clinical significance of major risk assessment tools,numerical simulation models,and early warning systems (EWS),in order to assist in the clinical management of PPH.

表1 CMQCC、AWHONN、NYSBOH 3种PPH 产前风险评估工具比较
工具名称 PPH风险类型 产前风险评估的具体内容
CMQCC 低风险 既往无子宫手术史、单胎妊娠,既往阴道分娩≤4次,无已知出血性疾病,无PPH病史
中等风险 既往剖宫产术分娩史或有子宫手术史,多胎妊娠,既往阴道分娩>4次,绒毛膜羊膜炎,既往PPH病史,巨大子宫肌瘤(直径≥10 cm),血细胞比容<0.30(血红蛋白含量<10 g/L),血小板计数为(50~100)×109/L,羊水过多,孕龄<37孕周或>41孕周被诊断为子痫前期,长时间分娩/引产(>24 h)
高风险 前置胎盘/低置胎盘,疑似/已知胎盘植入,突发子宫流血或活动性出血,凝血功能障碍,HELLP综合征,血细胞比容<0.24(血红蛋白含量<8 g/L),血小板计数<50×109/L,死胎,合并≥2个上述中等风险因素
AWHONN产前PPH风险预测工具 低风险 既往无子宫手术史,单胎妊娠,既往阴道分娩≤4次,无已知的出血性疾病,无PPH病史
中等风险 使用催产素或促宫颈成熟,多胎妊娠,既往阴道分娩>4次,既往剖宫产术分娩史或有子宫手术史,本次妊娠合并巨大子宫肌瘤(直径≥10 cm),既往1次PPH病史,一级直系亲属PPH病史,既往死胎史,羊水过多,绒毛膜羊膜炎
高风险 合并≥2项上述中等风险因素,潜在的子宫活动性出血,前置胎盘/低置胎盘,疑似胎盘黏连/植入,凝血功能障碍,既往多次PPH史,血细胞比容<0.30,血小板计数<100×109/L
NYSBOH 中等风险(产前因素) 前次剖宫产术分娩/子宫手术史/既往多次剖宫产术分娩史,多胎妊娠史,既往产次>4次,既往PPH史,本次预估胎儿出生体重≥4 kg,孕产妇肥胖(BMI>40 kg/m2),血细胞比容<0.3及其他
中等风险(产时因素) 绒毛膜羊膜炎,催产素使用>24 h,第二产程延长,产程中使用硫酸镁
高风险(产前因素) 合并≥2项上述产前中等风险因素,前置胎盘/低置胎盘,疑似感染/感染,血小板计数<70×109/L,活动性出血,凝血功能障碍
高风险(产时因素) 合并≥2项中等风险因素,发现子宫新的活动性出血
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