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A TEXTBOOK OF POSTPARTUM HEMORRHAGE - PART 2

có 266 trường hợp xuất huyết sau sinh, đại diện cho một tỷ lệ gần như bỏ lỡ xuất huyết sau sinh 7.9/1000 giao hàng. Prual và các đồng nghiệp đã kiểm tra bệnh tật nghiêm trọng mẹ từ nguyên nhân trực tiếp sản khoa ở Tây Phi từ năm 1994 đến 199632. Một sự kiện sản khoa nghiêm trọng được định nghĩa là prepartum, peripartum hoặc xuất huyết sau sinh dẫn đến truyền máu | Vital statistics Table 3 Postpartum hemorrhage PPH rates in Canada 1991-2000. Adapted from Wu Wen30 Number of cases 1991-2000 Rate per 1000 deliveries 95 CI Rate per 1000 deliveries 1991-1993 Rate per 1000 deliveries 1998-2000 Relative risk 95 CI PPH requiring transfusion 2317 0.91 0.87-0.95 1.27 0.63 0.5 0.44-0.55 PPH requiring hysterectomy 892 0.35 0.33-0.37 0.26 0.46 1.76 1.48-2.08 The 1991-1993 period was the reference period total there were 266 cases of postpartum hemorrhage representing a near-miss postpartum hemorrhage rate of 7.9 1000 deliveries. Prual and colleagues examined severe maternal morbidity from direct obstetric causes in West Africa between 1994 and 19 9 632. A severe obstetric event was defined as prepartum peripartum or postpartum hemorrhage leading to blood transfusion or hospitalization for more than 4 days or to hysterectomy. A total of 1307 severe maternal morbidity events were identified with obstetric hemorrhage representing the largest group involving 601 cases 342 of which were postpartum hemorrhage. The nearmiss obstetric hemorrhage rate was 30.5 CI 28.1-33.0 1000 live births and the near-miss postpartum hemorrhage rate was 17.4 CI 15.6-19.3 1000 live births. The Pretoria region of South Africa has used the same definition of near miss for over 5 years allowing comparison of temporal changes33. Rates per 1000 births for near misses plus maternal deaths over 5 years from severe postpartum hemorrhage are shown in Table 4. These rates are not dissimilar to those in Canada or the UK. ETIOLOGY AND PRECIPITATING FACTORS Causes of primary postpartum hemorrhage In recent years individual authors and academic groups have used the Four Ts pneumonic to provide a simplistic categorization of the causes of postpartum hemorrhage. This is shown in Table 534. Table 4 Rates per 1000 births for near misses plus maternal deaths from severe postpartum hemorrhage in Pretoria. Adapted from Pattinson et al.33 1997-99 2000 2001 2002 Rate 1000 births 0.96 .