Australian & New Zealand Journal of Obstetrics & Gynaecology最新文献_第4页

Routine Cord Blood Platelet Counts and Potential for Severe Neonatal Alloimmune Thrombocytopaenia (NAIT): A Cohort Study of 12 Yr. Experience at Middlemore Hospital, New Zealand 常规脐带血血小板计数和新生儿严重同种免疫性血小板减少症（NAIT）的可能性：一项12年队列研究。在新西兰米德尔莫尔医院工作经验。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-21 DOI: 10.1111/ajo.70065

Galama Vela, Jill H. Meyer, Michael P. Meyer

Background

Neonatal alloimmune thrombocytopaenia (NAIT) is a rare but potentially serious condition where maternal antibodies result in destruction of foetal and neonatal platelets. At Middlemore Hospital in south Auckland, routine cord blood platelet counts were performed over many years.

Aims

These were twofold: To determine the prevalence of severe thrombocytopaenia (TP) and severe NAIT and investigate platelet counts in siblings of infants with TP.

Materials and Methods

Cord blood was collected on all hospital births over 500 g over a 12-year period (2005–2016) and term infants with TP (< 150 × 10⁹/L) selected. Records of infants with severe TP (< 50 × 10⁹/L) were reviewed for potential NAIT cases. Records of siblings of infants with any degree of TP were also reviewed to examine the potential for NAIT in affected families.

Results

Of 68910 births, 62083 platelet counts were suitable for analysis and 641 term infants had TP (1%) with 16 having severe TP (0.025%). NAIT or potential NAIT was judged clinically to be present in half of these (0.013%). Most cases were of European ethnicity with a Maori infant and a Tongan infant also being possible cases. No serious complications were identified. 5% of siblings of infants with TP had low counts with only one infant having a likely diagnosis of severe NAIT.

Conclusions

Severe TP was uncommon amongst infants born in south Auckland where mothers of Maori and Pacific Island ethnicity make up the majority of the population. Performance of routine cord platelet counts was of limited value in detecting potential cases of severe NAIT.

背景：新生儿同种免疫性血小板减少症（NAIT）是一种罕见但潜在严重的疾病，母体抗体导致胎儿和新生儿血小板破坏。在奥克兰南部的米德尔莫尔医院，多年来一直进行常规脐带血血小板计数。目的：有双重目的：确定严重血小板减少症（TP）和严重NAIT的患病率，并调查患有TP的婴儿兄弟姐妹的血小板计数。材料与方法：收集2005-2016年12年间所有500g以上住院新生儿的脐带血，并选取TP （9/L）的足月婴儿。我们回顾了严重TP （9/L）患儿的记录，寻找潜在的NAIT病例。还审查了患有任何程度TP的婴儿的兄弟姐妹的记录，以检查受影响家庭中NAIT的可能性。结果：68910例新生儿中有62083例血小板计数适合分析，足月儿有足月病641例（1%），重度足月病16例（0.025%）。其中半数（0.013%）临床诊断为NAIT或潜在NAIT。大多数病例为欧洲族裔，一名毛利婴儿和一名汤加婴儿也可能是病例。未发现严重并发症。5%患有TP的婴儿的兄弟姐妹计数低，只有一个婴儿可能被诊断为严重的NAIT。结论：严重TP在奥克兰南部出生的婴儿中并不常见，那里的毛利人和太平洋岛屿民族的母亲占人口的大多数。常规脐带血小板计数在检测潜在严重NAIT病例中的价值有限。

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引用次数: 0

The Sociodemographic Benefits of Extending MS-2Step to 70 Days in Australia 澳大利亚将MS-2Step延长至70天的社会人口学效益

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-21 DOI: 10.1111/ajo.70077

Laura Slade, Jennie Louise, Katina D'Onise, Jodie Dodd

In many areas of the world, outpatient early medical abortion (EMA) is provided through mifepristone and misoprostol up to 10 weeks or 70 days gestation; however in Australia access is restricted to 63 days. A retrospective cohort study using South Australian data from 2012 to 2020 compares women undergoing abortion at less than 9 weeks with women undergoing abortion at less than 10 weeks. Currently, socioeconomic disadvantage is associated with a higher rate of presenting for abortion after 9 weeks. Extending EMA access would be of particular benefit for groups with socioeconomic disadvantage.

在世界上许多地区，门诊早期药物流产（EMA）是通过米非司酮和米索前列醇提供的，直至妊娠10周或70天；但在澳大利亚，入境限制为63天。一项回顾性队列研究使用了南澳大利亚州2012年至2020年的数据，比较了妊娠少于9周的妇女和妊娠少于10周的妇女。目前，社会经济劣势与9周后流产率较高有关。扩大EMA准入将特别有利于社会经济劣势群体。

引用次数: 0

Ultrasound Guidance to Reduce Complications During Uterine Curettage: A Systematic Review and Meta-Analysis 超声引导减少子宫刮除并发症：系统回顾和荟萃分析。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-21 DOI: 10.1111/ajo.70074

Sarah Dowthwaite, Ann Quinton, Samantha Thomas, Jillian Clarke

Background

Surgical management of pregnancy loss with retained products of conception (RPOC), may result in uterine perforation, incomplete evacuation, heavy blood loss, infection or cervical trauma. Ultrasound guidance could reduce complications.

Aims

To review studies on uterine curettage for RPOC comparing real-time ultrasound and blinded guidance and perform a meta-analysis to determine whether ultrasound reduces complications.

Materials and Methods

A systematic literature review was performed to identify studies on 24 August 2023 with further reference mining occurring up until 29 February 2024. Six studies with 1491 participants provided data on 585 participants assigned to ultrasound guidance and 906 assigned to blinded guidance. The measures of treatment effect for dichotomous outcomes—uterine perforation, RPOC, blood loss, infection and cervical trauma—were analysed and compared between the ultrasound and blinded group. A meta-analysis was performed for each outcome using inverse-variance and calculated I² to test heterogeneity. Estimated relative risk (95% CIs), odds ratio (OR, 95% CIs), absolute risk reduction and number needed to treat were calculated. Risk of bias was assessed using the Downs and Black tool and GRADE for certainty.

Results

Five studies including 1218 women provided data for persistent RPOC. Compared to blinded guidance, ultrasound-guided women had a decreased chance of persistent RPOC (OR, 0.19, 95% CI 0.08–0.43, I² 0%, high-certainty evidence). The association between ultrasound guidance and uterine perforation, blood loss, infection and cervical trauma was not significant, with serious concern for imprecision or inconsistency.

Conclusion

Ultrasound reduces the risk of persistent RPOC with a high certainty of evidence.

Trial Registration

Prospective register of systematic reviews (PROSPERO): CRD42023447614 (1st August 2023)

背景：流产伴孕产物残留（RPOC）的手术治疗可能导致子宫穿孔、不完全排出、大量失血、感染或宫颈外伤。超声引导可减少并发症。目的：回顾比较实时超声和盲法引导在RPOC子宫刮除术中的研究，并进行meta分析以确定超声是否能减少并发症。材料和方法：进行了系统的文献综述，以确定2023年8月24日的研究，并在2024年2月29日之前进行进一步的参考挖掘。6项研究共有1491名参与者，其中585名参与者被分配到超声指导组，906名参与者被分配到盲法指导组。分析和比较超声组和盲法组对子宫穿孔、RPOC、失血、感染、宫颈外伤的治疗效果。对每个结果进行荟萃分析，使用反方差和计算I2来检验异质性。计算估计相对危险度（95% ci）、优势比（OR, 95% ci）、绝对危险度降低和需要治疗的人数。使用Downs和Black工具评估偏倚风险，GRADE评估确定性。结果：包括1218名女性的5项研究提供了持续性RPOC的数据。与盲法引导相比，超声引导的女性发生持续性RPOC的几率降低（OR, 0.19, 95% CI 0.08-0.43, i20%，高确定性证据）。超声引导与子宫穿孔、失血、感染和宫颈外伤的相关性不显著，严重担心不准确或不一致。结论：超声可降低持续性RPOC的发生风险，证据确凿。试验注册：前瞻性系统评价注册（PROSPERO）： CRD42023447614（2023年8月1日）。

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引用次数: 0

Fertility and Obstetric Outcomes in Asherman Syndrome: Assessing the Impact of Hyaluronic Acid Post-Hysteroscopic Adhesiolysis 阿什曼综合征的生育和产科结局：评估宫腔镜下粘连松解术后透明质酸的影响。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-21 DOI: 10.1111/ajo.70071

Georgina Armstrong, Jason Abbott, Rebecca Deans

Background

Installation of hyaluronic acid following hysteroscopic adhesiolysis is suggested to reduce intrauterine adhesion (IUA) reformation in women with Asherman's Syndrome (AS). We aimed to assess the impact of hyaluronic acid following hysteroscopic adhesiolysis on menstrual, surgical, fertility, obstetric and neonatal outcomes.

Methods

We identified 128 women treated hysteroscopically for AS over an 11-year period and invited them to participate in a questionnaire-based study. A total of 43 women were included; 21 treated surgically with hyaluronic acid administered immediately following adhesiolysis and 22 having surgery alone. Outcomes were assessed by reviewing medical records retrospectively and using a structured questionnaire at 3 months and 4 years post procedure.

Results

There were no differences in the rates of repeat adhesiolysis procedures to treat recurrent IUAs between the treatment and control groups (19% vs. 18%, p = 0.94). All women in the treatment group reported resumption of menses 6 months following the procedure, with 9% in the control group reported ongoing amenorrhoea. There was no difference in the overall pregnancy rate (77% vs. 81%, p = 0.76), maternal and neonatal outcomes between the groups.

Conclusions

Intrauterine application of hyaluronic acid at the time of hysteroscopic adhesiolysis for women with AS was not associated with the number of repeat surgical interventions, menstrual patterns, fertility, obstetric, or neonatal outcomes.

背景：建议在宫腔镜粘连松解术后使用透明质酸，以减少阿什曼综合征（AS）妇女宫内粘连（IUA）的发生。我们旨在评估宫腔镜粘连松解术后透明质酸对月经、手术、生育、产科和新生儿结局的影响。方法：我们确定了128名在11年期间接受宫腔镜治疗的AS妇女，并邀请她们参加一项基于问卷的研究。总共包括43名妇女；21例手术治疗在粘连溶解后立即给予透明质酸，22例单独手术。在手术后3个月和4年，通过回顾医疗记录和使用结构化问卷来评估结果。结果：治疗组和对照组重复粘连松解术治疗复发性iua的比率无差异（19% vs. 18%, p = 0.94）。治疗组所有妇女在手术后6个月报告月经恢复，对照组9%报告持续闭经。两组之间的总妊娠率（77%对81%，p = 0.76）、产妇和新生儿结局均无差异。结论：宫腔镜下AS患者行粘连松解术时宫内应用透明质酸与重复手术干预次数、月经模式、生育能力、产科或新生儿结局无关。

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引用次数: 0

Severe Ovarian Hyperstimulation Syndrome (OHSS) After Gonadotrophin Releasing Hormone Agonist (GnRHa) Triggering 促性腺激素释放激素激动剂（GnRHa）触发后严重卵巢过度刺激综合征（OHSS）。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-17 DOI: 10.1111/ajo.70072

Olivia Slifirski, Genia Rozen, Chase Medwin, Nassar Nassar, Alex Polyakov

Background

Using a Gonadotrophin Releasing Hormone Agonist (GnRHa) trigger and freezing all eggs or embryos is the most effective strategy for preventing Ovarian Hyperstimulation Syndrome (OHSS) in IVF cycles. The literature predominantly suggests that severe OHSS can virtually be eliminated using the GnRHa trigger. The aim of this study was to determine the clinical characteristics and disease severity of OHSS in patients who received a GnRHa trigger compared to standard Human Chorionic Gonadotropin (HCG) trigger.

Materials and Methods

Retrospective cohort study of patients with OHSS admitted to a single tertiary referral hospital over a five-year period, from January 2016 to December 2021. HCG and GnRHa trigger cohorts were compared with respect to baseline characteristics, IVF cycle characteristics and OHSS outcomes.

Results

Of 150 cases of severe OHSS requiring admission, 24 (16%) occurred after a GnRHa trigger and 126 (84%) occurred after an HCG trigger. Baseline characteristics were not significantly different. Baseline AMH and the number of oocytes retrieved were significantly higher in the GnRHa group ((69.6 versus 41.4 p < 0.0001) and (28.3 versus 21.7 p = 0.0038) respectively). There was no significant difference in most markers of clinical severity or length of hospital admission.

Conclusions

Using a GnRHa trigger and freeze-all protocol reduces but does not eliminate OHSS in high-risk women. Further preventative strategies may be necessary in this population.

背景：使用促性腺激素释放激素激动剂（GnRHa）触发和冷冻所有卵子或胚胎是预防IVF周期卵巢过度刺激综合征（OHSS）最有效的策略。文献主要表明，严重的OHSS实际上可以使用GnRHa触发器消除。本研究的目的是确定接受GnRHa触发与标准人绒毛膜促性腺激素（HCG）触发的OHSS患者的临床特征和疾病严重程度。材料和方法：对2016年1月至2021年12月在一家三级转诊医院住院的OHSS患者进行回顾性队列研究。比较HCG和GnRHa触发队列的基线特征、IVF周期特征和OHSS结果。结果：在150例需要入院的严重OHSS中，24例（16%）发生在GnRHa触发后，126例（84%）发生在HCG触发后。基线特征无显著差异。GnRHa组的基线AMH和卵母细胞数量明显更高（69.6 vs 41.4 p）。结论：使用GnRHa触发和冻结方案可减少但不能消除高危妇女的OHSS。在这一人群中可能需要进一步的预防策略。

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引用次数: 0

Clinical Implementation of RHD NIPT in a Tertiary Obstetric Centre in Western Australia RHD NIPT在西澳大利亚三级产科中心的临床实施。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-17 DOI: 10.1111/ajo.70067

Jennifer Leverington, Anastazia Keegan, Dimitar N. Azmanov, Jan E. Dickinson

A clinically robust RHD non-invasive prenatal test (RHD NIPT) was developed to predict fetal RhD status and optimise RhD Ig use for RhD-negative pregnant women in Western Australia. Using rigorous methodology and stakeholder engagement we created clinical guidelines and educational support tools, such as reference guides and consumer brochures, to enhance test uptake. Six months post-implementation, 90% of healthcare professionals surveyed felt confident offering the test, with 87% having ordered it. A guideline review of 50 women confirmed they all received appropriate RhD Ig use. This successful implementation of RhD NIPT screening in our tertiary obstetric centre ensured safe, targeted care for RhD-negative pregnancies.

在西澳大利亚，一种临床可靠的RHD无创产前检查（RHD NIPT）被开发出来，用于预测胎儿RHD状态，并优化RHD Ig在RHD阴性孕妇中的应用。使用严格的方法和利益相关者的参与，我们创建了临床指南和教育支持工具，如参考指南和消费者手册，以提高测试的接受度。实施六个月后，接受调查的90%的医疗保健专业人员有信心提供这项测试，87%的人已经订购了这项测试。一项对50名妇女的指南审查证实她们都接受了适当的RhD Ig治疗。在我们的三级产科中心成功实施了RhD NIPT筛查，确保了对RhD阴性妊娠的安全、有针对性的护理。

引用次数: 0

Demographic Factors Influencing Eligibility for EMA in South Australia 影响南澳大利亚州EMA资格的人口因素。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-17 DOI: 10.1111/ajo.70069

Laura Slade, Jennie Louise, Katina D'Onise, Jodie Dodd

Background

Early medical abortion (EMA) can be performed by administration of mifepristone and misoprostol in an outpatient setting prior to 63 days gestation in Australia. While this is a flexible, efficacious and safe option for abortion, it requires early identification of pregnancy and efficient access to a clinical service. Outpatient EMA with mifepristone and misoprostol was introduced in Australia in 2012 for gestations < 49 days, and extended to 63 days in 2015.

Methods

The laws governing abortion in South Australia mandate routine data collection. A retrospective cohort study was conducted of all registered abortions in South Australia from 2012 to 2020. Women undergoing abortion before 7 weeks gestation between 2012 and 2014 and then from 2015 those undergoing abortion before 9 weeks gestation were considered EMA eligible. Demographic characteristics were then compared using multiple logistic regression.

Results

Women who were eligible for EMA were significantly different from those who were ineligible based on gestational age. Women who were ineligible were more likely to be teenagers, live in rural and remote areas and live in areas of socio-economic disadvantage. In multivariable logistic regression teenagers were disproportionately less likely to be EMA eligible, with rural women and socially disadvantaged teenagers having the lowest rates of and eligibility for EMA.

Conclusion

Eligibility for EMA was affected by age, rurality and socio-economic disadvantage. Interventions to improve access should investigate and address the specific barriers facing these groups of women.

背景：早期药物流产（EMA）可以在澳大利亚妊娠63天前门诊使用米非司酮和米索前列醇进行。虽然这是一种灵活、有效和安全的堕胎选择，但它需要及早发现妊娠并有效地获得临床服务。2012年，澳大利亚引入了米非司酮和米索前列醇的门诊EMA，用于妊娠。方法：南澳大利亚州有关堕胎的法律要求常规数据收集。对2012年至2020年南澳大利亚所有登记的堕胎进行了回顾性队列研究。2012年至2014年间妊娠7周前堕胎的妇女以及2015年妊娠9周前堕胎的妇女被认为符合EMA条件。然后使用多元逻辑回归比较人口统计学特征。结果：符合EMA条件的妇女与根据胎龄不符合EMA条件的妇女显著不同。不符合条件的妇女更有可能是青少年，生活在农村和偏远地区，生活在社会经济不利的地区。在多变量logistic回归中，青少年获得EMA资格的可能性不成比例地低，农村妇女和社会弱势青少年获得EMA的比例和资格最低。结论：EMA的资格受年龄、农村和社会经济条件的影响。改善获得机会的干预措施应调查和解决这些妇女群体面临的具体障碍。

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引用次数: 0

How Do Australian Physiotherapists Clinically Manage People With Symptomatic Endometriosis and Vulvodynia? A Survey of Current Practice Among Australian Physiotherapists 澳大利亚物理治疗师如何临床管理有症状的子宫内膜异位症和外阴痛的人？澳大利亚物理治疗师的当前实践调查。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-17 DOI: 10.1111/ajo.70073

K. Jane Chalmers, Joshua Dardaneliotis, Astha Malik, Mike Armour

Background

A growing body of evidence suggests that pelvic health physiotherapy is an effective, low-risk management strategy for women with endometriosis and vulvodynia. However, to date no study has identified which interventions Australian pelvic health physiotherapists are implementing in clinical practice to treat women with endometriosis and vulvodynia.

Aims

This study aimed to identify which interventions are used to treat women with endometriosis and vulvodynia, as well as increase knowledge surrounding the professional qualifications, workplace settings and information sources of these clinicians.

Materials and Methods

A cross-sectional online survey was distributed to Australian physiotherapists. Survey questions included those on workplace characteristics, information sources and intervention selection and frequency. Data were analysed using descriptive statistics.

Results

151 responses were included for analysis. Most respondents (74.2%) worked in private practice. Advice from colleagues or mentors was the most used information source when deciding how to treat women's pelvic health conditions. For both endometriosis and vulvodynia, pain or lifestyle education, pelvic floor down-training, relaxation, exercise and stretching/flexibility were the five most frequently used interventions.

Conclusions

Australian physiotherapists are using a mixture of evidence-based and non-evidence-based interventions to treat women with endometriosis and vulvodynia. There is an urgent need for further high-quality studies investigating intervention efficacy and safety for physiotherapy interventions in women with endometriosis and vulvodynia.

背景：越来越多的证据表明盆腔健康理疗是子宫内膜异位症和外阴痛女性的一种有效、低风险的治疗策略。然而，到目前为止，还没有研究确定澳大利亚盆腔健康物理治疗师在临床实践中实施哪些干预措施来治疗子宫内膜异位症和外阴痛。目的：本研究旨在确定哪些干预措施可用于治疗子宫内膜异位症和外阴痛的妇女，并增加有关这些临床医生的专业资格，工作场所设置和信息来源的知识。材料和方法：对澳大利亚物理治疗师进行横断面在线调查。调查问题包括工作场所特征、信息来源和干预措施的选择和频率。数据分析采用描述性统计。结果：151份问卷被纳入分析。大多数受访者（74.2%）在私人执业。在决定如何治疗女性盆腔疾病时，来自同事或导师的建议是最常用的信息来源。对于子宫内膜异位症和外阴痛，疼痛或生活方式教育，盆底向下训练，放松，运动和拉伸/柔韧性是五种最常用的干预措施。结论：澳大利亚物理治疗师正在使用循证和非循证干预相结合的方法来治疗子宫内膜异位症和外阴痛。对于子宫内膜异位症和外阴痛的女性，物理治疗干预的有效性和安全性，迫切需要进一步的高质量研究。

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引用次数: 0

Cannabis and Endometriosis: When Is an Adverse Effect Not Adverse? 大麻和子宫内膜异位症：什么时候不是不良影响？

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-17 DOI: 10.1111/ajo.70076

Justin Sinclair, Hannah Adler, Allie Eathorne, Orit Holtzman, Carolyn Ee, Jason Abbott, Jerome Sarris, Mike Armour

There is growing evidence that people with endometriosis are utilising cannabis, whether legally or illicitly procured, for management of pain and associated symptoms. As such, concerns over cannabis use as a medicine are foremost in clinicians' minds, particularly potential adverse effects. This study, a sub-set of a larger (n = 889) international survey investigating the self-reported effectiveness, safety and pharmaceutical de-prescribing trends of cannabis use in the endometriosis population, showed that 32% experienced side-effects associated with cannabis use, similar to published literature. However, some of these reported adverse effects have potential clinical utility and may require a more nuanced interpretation.

越来越多的证据表明，患有子宫内膜异位症的人正在使用大麻，无论是合法的还是非法的，来控制疼痛和相关症状。因此，临床医生最关心的是将大麻作为药物使用，特别是潜在的副作用。这项研究是一项更大的（n = 889）国际调查的子集，该调查调查了子宫内膜异位症人群中大麻使用的自我报告有效性、安全性和药物处方减少趋势，结果显示32%的人经历了与大麻使用相关的副作用，与已发表的文献相似。然而，一些报道的不良反应有潜在的临床用途，可能需要更细致的解释。

引用次数: 0

Risk Factors for Secondary Postpartum Haemorrhage: Preliminary Data for a Longitudinal Prospective Cohort Study Involving Women Presenting to a Single Tertiary Women's Hospital 继发性产后出血的危险因素：一项纵向前瞻性队列研究的初步数据，该研究涉及到一家三级妇女医院就诊的妇女。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-11-13 DOI: 10.1111/ajo.70075

Jessica Anderson, Nicole Young, Rachael Fox, Laura Davis, Erin Cvejic, Samantha S. Mooney

Background

Secondary postpartum haemorrhage (PPH) complicates approximately 1% of pregnancies and can cause significant morbidity. Understanding predisposing factors may aid its prevention and management.

Aims

To identify and assess risk factors for presentation to the emergency department with secondary PPH, including factors associated with increased severity and need for surgical management or inpatient care.

Materials and Methods

In this prospective observational study, patients who presented to a metropolitan Melbourne women's hospital (‘Level 6’ maternity referral centre) with secondary PPH between 1/7/2020 and 31/12/2021 were eligible for recruitment. Prospective clinical and demographic data was collected at time of emergency presentation; antenatal and intrapartum information were collected by review of medical records. Antenatal, birth and postpartum variables of those identified as presenting with a secondary PPH were compared with control participants who birthed at the institution in the same period. Comparisons were made using chi-square tests, independent sample t-tests and Mann–Whitney U tests as appropriate.

Results

168 patients who experienced a secondary PPH were recruited and compared with 9491 controls. Factors associated with secondary PPH included younger maternal age (p = 0.004), lower parity (p = 0.013), higher plurality (p < 0.001), being born in Australia (p = 0.008), incomplete placenta and/or membranes (p < 0.001), greater blood loss at birth (p = 0.014) and infant formula feeding on discharge (p = 0.019). Some of these factors, as well as others, were also associated with increased severity of secondary PPH, surgical management or inpatient care.

Conclusions

Secondary PPH is a significant problem with associated risk factors. Further research should look at preventative mechanisms for secondary PPH.

Trial Registration

Australian New Zealand Clinical Trials Registry registration number: ACTRN12622000039785

背景：继发性产后出血（PPH）并发症约占妊娠的1%，可引起显著的发病率。了解诱发因素有助于其预防和管理。目的：识别和评估继发性PPH出现在急诊科的危险因素，包括与严重程度增加和需要手术治疗或住院治疗相关的因素。材料和方法：在这项前瞻性观察性研究中，在2020年7月1日至2021年12月31日期间，在墨尔本大都会妇女医院（“6级”产科转诊中心）就诊的继发性PPH患者符合招募条件。在急诊就诊时收集前瞻性临床和人口统计数据；通过查阅医疗记录收集产前和产时信息。产前、分娩和产后变量被确定为出现二次PPH的参与者与同期在该机构出生的对照组参与者进行比较。比较采用卡方检验、独立样本t检验和Mann-Whitney U检验。结果：168名经历继发性PPH的患者被招募，并与9491名对照组进行比较。继发性PPH的相关因素包括产妇年龄小（p = 0.004）、胎次低（p = 0.013）、胎次多(p)。结论：继发性PPH存在显著的相关危险因素。进一步的研究应该着眼于继发性PPH的预防机制。试验注册：澳大利亚新西兰临床试验注册中心注册号：ACTRN12622000039785。

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