Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2024, Vol. 20 ›› Issue (05): 498 -503. doi: 10.3877/cma.j.issn.1673-5250.2024.05.004

Special Column of Frontiers in Obstetrics

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

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
[1]
刘兴会, 陈锰.严重产后出血的早期预警[J/OL].中华妇幼临床医学杂志(电子版),2016,12(5):497-500.DOI:10.3877/cma.j.issn.1673-5250.2016.05.001.Liu XH,Chen M.Early warning of severe postpartum hemorrhage[J/OL].Chin J Obstet Gynecol Pediatr(Electron Ed),2016,12(5):497-500.DOI:10.3877/cma.j.issn.1673-5250.2016.05.001.
[2]
Bienstock JL,Eke AC,Hueppchen NA.Postpartum hemorrhage[J].New Engl J Med,2021,384(17):1635-1645.DOI:10.1056/NEJMra1513247.
[3]
石慧峰, 陈练, 王晓霞, 等.2016—2019年中国严重产后出血的流行病学现状和变化趋势[J].中华妇产科杂志,2021,56(7):451-457.DOI:10.3760/cma.j.cn112141-20210209-00070.Shi HF,Chen L,Wang XX,et al.Epidemiological status and trends of severe postpartum hemorrhage in China from 2016 to 2019[J].Chin J Obstet Gynecol,2021,56(7):451-457.DOI:10.3760/cma.j.cn112141-20210209-00070.
[4]
杨怡珂, 王妍, 赵扬玉.产后出血救治中的表单化管理[J/OL].中华产科急救电子杂志,2023,12(1):60-63.DOI:10.3877/cma.j.issn.2095-3259.2023.01.014.Yang YK,Wang Y,Zhao YY.Form based management in the treatment of postpartum hemorrhage [J/OL].Chin J Obstet Emerg (Electronic Edition),2023,12(1):60-63.DOI:10.3877/cma.j.issn.2095-3259.2023.01.014.
[5]
中华医学会妇产科学分会产科学组, 中华医学会围产医学分会.产后出血预防与处理指南(2023)[J].中华妇产科杂志,2023,58(6):401-409.DOI:10.3760/cma.j.cn112141-20230223-00084.Obstetrics Subgroup,Chinese Society of Obstetrics and Gynecology,Chinese Medical Association;Chinese Society of Perinatal Medicine,Chinese Medical Association.Guidelines for prevention and treatment of postpartum hemorrhage(2023) [J]Chin J Obstet Gynecol,2023,58(6):401-409.DOI:10.3760/cma.j.cn112141-20230223-00084.
[6]
Ende HB,James LM,Chestnut DH,et al.Risk factors for atonic postpartum hemorrhage:a systematic review and Meta-analysis[J].Obstet Gynecol,2021,137(2):305-323.DOI:10.1097/AOG.0000000000004228.
[7]
Tang D,Cheng YF,Feng XS,et al.The use of IVF/ICSI and risk of postpartum hemorrhage:a retrospective cohort study of 153,765 women in China[J].Front Publ Health,2023,11:1016457.DOI:10.3389/fpubh.2023.1016457.
[8]
Liu CN,Yu FB,Xu YZ,et al.Prevalence and risk factors of severe postpartum hemorrhage:a retrospective cohort study[J].BMC Pregnancy Childbirth,2021,21(1):332.DOI:10.1186/s12884-021-03818-1.
[9]
California Maternal Quality Care Collaborative.OB hemorrhage toolkit V3.0[EB/OL].(2015) [2024-08-15].https://www.cmqcc.org/resources-tool-kits/toolkits/obhemorrhage-toolkit.
[10]
Main EK,Cape V,Abreo A,et al.Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative[J].AM J Obstet Gynecol,2017,216(3):298.e1-298.e11.DOI:10.1016/j.ajog.2017.01.017.
[11]
The awhonn postpartum hemorrhage project.Postpartum hemorrhage(PPH)risk assessment table 1.0[EB/OL].(2019-09-18)[2024-08-15].https://mygnosis.com/Content/Chunks/3504/asset s/pdfs/PPH_Risk_Assessent_Table-7-17-15.pdf.
[12]
American College of Obstetricians and Gynecologists.Maternal safety bundle for obstetric hemorrhage[EB/OL].(2019-08-20) [2024-08-15].https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/HEMSlideSet Nov2015.pdf? dmc51&ts520190820T2308033042.
[13]
Burgansky A,Montalto D,Siddiqui NA.The safe motherhood initiative:the development and implementation of standardized obstetric care bundles in New York[J].Semi Perinatol,2016,40(2):124-131.DOI:10.1053/j.semperi.2015.11.019.
[14]
Lengerich BJ,Caruana R,Painter I,et al.Interpretable machine learning predicts postpartum hemorrhage with severe maternal morbidity in a lower-risk laboring obstetric population[J].Am J Obstet Gynecol MFM,2024,6(8):101391.DOI:10.1016/j.ajogmf.2024.101391.
[15]
Westcott JM,Hughes F,Liu W,et al.Prediction of maternal hemorrhage using machine learning:retrospective cohort study[J].J Med Internet Res,2022,24(7):e34108.DOI:10.2196/34108.
[16]
Klumpner TT,Kountanis JA,Meyer SR,et al.Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to detect severe postpartum hemorrhage[J].Anesth Analges,2020,131(3):857-865.DOI:10.1213/ANE.0000000000004605.
[17]
Umar A,Ameh CA,Muriithi F,et al.Early warning systems in obstetrics:a systematic literature review[J].PLoS One,2019,14(5):e0217864.DOI:10.1371/journal.pone.0217864.
[18]
Hannola K,Hoppu S,Mennander S,et al.Obstetric early warning system to predict maternal morbidity of preeclampsia,postpartum hemorrhage and infection after birth in high-risk women:a prospective cohort study [J].Midwifery,2021,99:103015.DOI:10.1016/j.midw.2021.103015.
[19]
Dilla AJ,Waters JH,Yazer MH.Clinical validation of risk stratification criteria for peripartum hemorrhage[J].Obstet Gynecol,2013,122 (1):120-126.DOI:10.1097/AOG.0b013e3182941c78.
[20]
Kawakita T,Mokhtari N,Huang JC,et al.Evaluation of risk-assessment tools for severe postpartum hemorrhage in women undergoing cesarean delivery[J].Obstet Gynecol,2019,134(6):1308-1316.DOI:10.1097/AOG.0000000 000003574.
[21]
Martins RIL,Novais JSM,Reis ZSN.Postpartum hemorrhage in electronic health records:risk factors at admission and in-hospital occurrence[J].Revist Brasil Ginecol Obstet,2024,46:e-rbgo14.DOI:10.61622/rbgo/2024AO14.
[22]
Dang XH,Zhang L,Bao YD,et al.Developing and validating nomogram to predict severe postpartum hemorrhage in women with placenta previa undergoing cesarean delivery:a multicenter retrospective case-control study[J].Front Med (Lausanne),2021,8:789529.DOI:10.3389/fmed.2021.789529.
[23]
Du L,Feng L,Bi SL,et al.Probability of severe postpartum hemorrhage in repeat cesarean deliveries:a multicenter retrospective study in China[J].Sci Rep,2021,11(1):8434.DOI:10.1038/s41598-021-87830-7.
[24]
魏璐, 罗剑儒, 邓洪, 等.胎盘前置状态孕妇产后出血评分模型的建立及应用[J/OL].中华妇幼临床医学杂志(电子版),2020,16(1):114-119.DOI:10.3877/cma.j.issn.1673-5250.2020.01.015.Wei L,Luo JR,Deng H,et al.Establishment and application of postpartum hemorrhage scoring model for pregnant women with placenta previa status[J/OL].Chin J Obstet Gynecol Pediatr (Electron Ed),2020,16(1):114-119.DOI:10.3877/cma.j.issn.1673-5250.2020.01.015.
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