Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study.

IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY BMC Pregnancy and Childbirth Pub Date : 2024-10-24 DOI:10.1186/s12884-024-06875-4
Xiaohan Xu, Yuelun Zhang, Xuerong Yu, Yuguang Huang
{"title":"Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study.","authors":"Xiaohan Xu, Yuelun Zhang, Xuerong Yu, Yuguang Huang","doi":"10.1186/s12884-024-06875-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10-1.48], anemia (aOR 1.66; 95% CI 1.34-2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39-5.05), coagulopathy (aOR 25.92; 95% CI 8.59-69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86-4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04-2.47), uterine scar (aOR 1.39; 95% CI 1.15-1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74-4.38), polyhydramnios (aOR 2.52; 95% CI 1.19-4.68) and placenta previa (aOR 25.03; 95% CI 21.04-29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.</p><p><strong>Conclusions: </strong>Ten risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515422/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Pregnancy and Childbirth","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12884-024-06875-4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.

Methods: We conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.

Results: A total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10-1.48], anemia (aOR 1.66; 95% CI 1.34-2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39-5.05), coagulopathy (aOR 25.92; 95% CI 8.59-69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86-4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04-2.47), uterine scar (aOR 1.39; 95% CI 1.15-1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74-4.38), polyhydramnios (aOR 2.52; 95% CI 1.19-4.68) and placenta previa (aOR 25.03; 95% CI 21.04-29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.

Conclusions: Ten risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
产前风险因素与选择性剖腹产大量输血的结果:一项全国性回顾性队列研究。
背景:产后出血是导致产妇死亡和发病的主要原因之一。产后出血的病因与分娩方式有关,因此,择期剖宫产产妇大量输血的风险因素可能与阴道分娩或急诊剖宫产产妇大量输血的风险因素不同。本研究的主要目的是调查择期剖宫产产前大量输血的风险因素:方法:我们根据全国范围内三级医院住院病历系统的数据进行了一项回顾性队列研究。我们纳入了 2013 年 1 月至 2018 年 8 月期间接受择期剖宫产手术的产妇。主要结果是大量输血,定义为分娩当天输血超过8个单位的红细胞。候选风险因素由第十版《国际疾病分类》入院诊断代码确定。采用多变量逻辑回归法评估了每个因素与大量输血之间的关系:结果:共纳入 294,695 名产妇,其中 572 人接受了大量输血(发生率:每 100,000 例选择性剖宫产 194 人)。产妇年龄[调整赔率(aOR)1.22;95% 置信区间(CI)1.10-1.48]、贫血(aOR 1.66;95% CI 1.34-2.05)、血小板减少(aOR 3.54;95% CI 2.39-5.05)、凝血功能障碍(aOR 25.92;95% CI 8.59-69.50)、低白蛋白血症(aOR 2.97;95% CI 1.86-4.53)、肝功能障碍(aOR 1.65;95% CI 1.04-2.47)、子宫疤痕(aOR 1.39;95% CI 1.15-1.67)、多胎妊娠(aOR 2.84;95% CI 1.74-4.38)、多羊水(aOR 2.52;95% CI 1.19-4.68)和前置胎盘(aOR 25.03;95% CI 21.04-29.77)与选择性剖宫产大量输血有关。在接受大量输血的产妇中,7 人(1.2%)在住院期间死亡,126 人(22.0%)需要切除子宫,25 人(4.4%)需要子宫填塞术,57 人(10.0%)需要子宫动脉结扎术:结论:在接受择期剖宫产手术的妇女中发现了十种导致大量输血的风险因素。我们的研究结果可能有助于血液制品的准备工作,并为剖宫产术前对大量输血高危产妇采取预防性策略提供了机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth OBSTETRICS & GYNECOLOGY-
CiteScore
4.90
自引率
6.50%
发文量
845
审稿时长
3-8 weeks
期刊介绍: BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
期刊最新文献
Determinants of retroplacental hematoma at the Maradi mother and child health center, Niger: a case‒control study. Providers' perspective on vaginal birth after cesarean birth: a qualitative systematic review. The impact of scaling and root planning combined with mouthwash during pregnancy on preterm birth and low birth weight: a systematic review and meta-analysis. Outcomes of peripartum cardiomyopathy in North Africa: insights from a single-center observational study in Tunisia. Perspectives of midwives on respectful maternity care.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1