A History of Cesarean Birth as a Risk Factor for Postpartum Hemorrhage Even After Successful Planned Vaginal Birth.

IF 2.8 3区医学 Q1 NURSING Birth-Issues in Perinatal Care Pub Date : 2024-11-11 DOI:10.1111/birt.12892

J Boujenah, M Belabbas, A Tigaizin, A Benbara, I Hensienne, M Fermaut, L Carbillon

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Abstract

Background: It is unclear if a history of cesarean birth (CB) is a risk factor for postpartum hemorrhage (PPH) even after a successful planned vaginal birth.

Methods: A historical retrospective cohort study from all deliveries (42,456) between 2004 and 2019. Inclusion criteria were as follows: (i) women with only one previous CB; (ii) liveborn cephalic singleton pregnancy and term spontaneous labor; (iii) successful planned vaginal birth; (iv) no operative vaginal delivery; and (v) no history of PPH. Women who experienced intrapartum uterine rupture leading to CB were excluded. Those who experienced uterine rupture diagnosed after vaginal birth were not excluded. The labor after cesarean (LAC) group (109 women with previous CB and current vaginal birth) were compared with 2 control groups to consider the parity: control group 1 (1633 nulliparous women) and control group 2 (4197 parous women). The main outcome was the rate of PPH (> 500 mL). Multivariate analysis was performed to investigate whether previous CB was an independent risk factor for PPH. Bivariate analysis and causal framework was used to determine the relation between variables of clinical interest.

Results: The PPH rates in the LAC group, control group 1, and control group 2 were 12.8%, 5.3%, and 6.4%, respectively. Irrespective of the group control (1 or 2), a history of CB was associated with an increased risk of PPH: adjusted odds ratio (aOR) 2.38 [95% confidence interval (CI) 1.28-4.44] (adjusted with maternal age, overweight, hyperthermia, and use of oxytocin) and aOR 2.16 [95% CI 1.20-3.87] (adjusted with maternal age and overweight) for Groups 1 (parous) and 2 (nulliparous), respectively.

Conclusion: A history of cesarean birth could be a risk factor for PPH even after successful planned vaginal delivery.

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剖腹产史是产后出血的风险因素之一，即使是在成功的阴道分娩计划之后。

背景：目前尚不清楚剖宫产史（CB）是否是产后出血（PPH）的风险因素，即使是在成功的计划阴道分娩后：方法：对 2004 年至 2019 年期间的所有分娩（42456 例）进行历史回顾性队列研究。纳入标准如下(i) 仅有过一次 CB 的产妇；(ii) 活产头位单胎妊娠和足月自然分娩；(iii) 顺利经阴道分娩；(iv) 未进行阴道分娩手术；(v) 无 PPH 病史。排除了产中子宫破裂导致 CB 的产妇。不排除阴道分娩后诊断为子宫破裂的产妇。剖宫产后分娩（LAC）组（109 名曾有过剖宫产经历且目前经阴道分娩的产妇）与两组对照组进行了比较，以考虑其奇偶性：对照组 1（1633 名无阴道分娩的产妇）和对照组 2（4197 名有阴道分娩经历的产妇）。主要结果是 PPH（> 500 毫升）发生率。进行了多变量分析以研究既往 CB 是否是 PPH 的独立风险因素。双变量分析和因果框架用于确定临床相关变量之间的关系：LAC组、对照组1和对照组2的PPH发生率分别为12.8%、5.3%和6.4%。无论对照组是第 1 组还是第 2 组，剖宫产史都与 PPH 风险的增加有关：第 1 组（顺产）和第 2 组（非顺产）的调整赔率（aOR）分别为 2.38 [95% 置信区间（CI）1.28-4.44]（与产妇年龄、超重、高热和催产素的使用进行调整）和 2.16 [95% CI 1.20-3.87]（与产妇年龄和超重进行调整）：结论：剖宫产史可能是PPH的一个风险因素，即使是在顺利通过阴道分娩的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Birth-Issues in Perinatal Care 医学-妇产科学

CiteScore

4.10

自引率

4.00%

发文量

审稿时长

>12 weeks

期刊介绍： Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.