Early recognition and diagnosis of postpartum hemorrhage

doi:10.3877/cma.j.issn.2095-3259.2022.03.005

Abstract

Abstract:

Postpartum hemorrhage is a common obstetric complication and the leading cause of maternal mortality worldwide. How to detect and block the process of postpartum hemorrhage in time plays an important role in preventing maternal death. Accurate assessment of blood loss, early identification of risk factors and timely diagnosis of postpartum hemorrhage are the basic requirements and must be mastered in the diagnosis and treatment of postpartum hemorrhage. This article reviews and summarizes the evaluation of blood loss, the identification of risk factors, and the monitoring of clinical symptoms, signs, and laboratory tests, to provide a reference for clinical work.

Key words: Postpartum hemorrhage, Risk factors, Diagnosis

Xin Dong, Xuelan Li. Early recognition and diagnosis of postpartum hemorrhage[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2022, 11(03): 144-147.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhckjjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3259.2022.03.005

https://zhckjjdzzz.cma-cmc.com.cn/EN/Y2022/V11/I03/144

Figures/Tables 1

References 31

[1]	Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis [J]. Lancet Glob Health, 2014，2(6)：e323-333.
[2]	中华医学会妇产科学分会产科学组. 产后出血预防与处理指南(2014)[J]. 中华妇产科杂志，2014，49(9)：641-646.
[3]	Menard MK, Main EK, Currigan SM. Executive summary of the reVITALize initiative: Standardizing obstetric data definitions [J]. Obstet Gynecol, 2014, 124(1)：150-153.
[4]	Gonzalez-Brown V, Schneider P. Prevention of postpartum hemorrhage [J]. Semin Fetal Neonatal Med, 2020, 25(5)：1-7.
[5]	Rothermel LD, Lipman JM. Estimation of blood loss is inaccurate and unreliable [J]．Surgery, 2016，160(4)：946-953.
[6]	张一剑，陈敦金. 产后出血定义及诊治进展[J/CD]. 中华产科急救电子杂志，2022，11(2): 121-124.
[7]	Buckland SS, Homer CS. Estimating blood loss after birth: Using simulated clinical examples [J]．Women Birth, 2007，20(2)：85-88.
[8]	Brooks M, Legendre G, Brun S, et al. Use of a Visual Aid in addition to a Collector Bag to Evaluate Postpartum Blood loss: A Prospective Simulation Study [J]．Sci Rep, 2017，7：1-7.
[9]	Larsson C, Saltvedt S, Wiklund I, et al. Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration [J]．Acta Obstet Gynecol Scand, 2006, 85(12)：1448-1452.
[10]	Toledo P, Eosakul ST, Goetz K, et al. Decay in blood loss estimation skills after web-based didactic training [J]．Simul Healthc, 2012, 7(1)：18-21.
[11]	Andrikopoulou M, D′Alton ME. Postpartum hemorrhage: early identification challenges [J]. Semin Perinatol, 2019, 43(1)：11-17.
[12]	Lertbunnaphong T, Lapthanapat N, Leetheeragul J, et al. Postpartum blood loss: visual estimation versus objective quantification with a a novel birthing drape[J]. Singapore Med J, 2016, 57(6)：325-328.
[13]	Rubenstein AF, Zamudio S, Al-Khan A, et al. Clinical Experience with the Implementation of Accurate Measurement of Blood Loss[J]. Am J Perinatol, 2018, 35(7)：655-659.
[14]	Anger H, Durocher J, Dabash R, et al. How well do postpartum blood loss and common definitions of postpartum hemorrhage [J]. PLoS One, 2019, 14(8)：1-13.
[15]	American College of Obstetricians and Gynecologists. Quantitative Blood Loss in Obstetric Hemorrhage：ACOG COMMITTEE OPINION, Number 794 [J]. Obstet Gynecol，2019，134(6)：e150-e156.
[16]	Zhang WH, Deneux-Tharaux C, Brocklehurst P, et al. Effect of a collector bag for measurement of postpartum blood loss after vaginal delivery: cluster randomised trial in 13 European countries[J]. BMJ, 2010, 340：1-8.
[17]	Diaz V, Abalos E, Carroli G. Methods for blood loss estimation after vaginal birth [J]. Cochrane Database Syst Rev, 2018, 9(9)：1-32.
[18]	Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions [J]．Curr Opin Anaesthesiol，2019, 32(3)：278-284.
[19]	Henriquez DDCA, Bloemenkamp KWM, van der Bom JG. Management of postpartum hemorrhage: how to improve maternal outcomes? [J]．J Thromb Haemost, 2018, 16(8): 1523-1534.
[20]	Borovac-Pinheiro A, Pacagnella RC, Cecatti JG, et al. Postpartum hemorrhage: new insights for definition and diagnosis [J]. Am J Obstet Gynecol, 2018, 219(2)：162-168.
[21]	Sohn CH, Kim WY, Kim SR, et al. An increase in initial shock index is associated with the requirement for massive transfusion in emergency department patients with primary postpartum hemorrhage [J]. Shock, 2013, 40(2): 101-105.
[22]	Nathan HL, Cottam K, Hezelgrave NL, et al. Determination of Normal Ranges of Shock Index and Other Haemodynamic Variables in the Immediate Postpartum Period: A Cohort Study [J]. PloS one, 2016, 11(12)：1-10.
[23]	Le Bas A, Chandraharan E, Addei A, et al. Use of the " obstetric shock index" as an adjunct in identifying significant blood loss in patients with massive postpartum hemorrhage [J]. Int J Gynaecol Obstet, 2014, 124(3)：253-255.
[24]	Shields LE, Wiesner S, Klein C, et al. Use of Maternal Early Warning Trigger tool reduces maternal morbidity [J]. Am J Obstet Gynecol, 2016, 214(4)：527.e521-e526.
[25]	Rath WH. Postpartum hemorrhage-update on problems of definitions and diagnosis [J]. Acta Obstet Gynecol Scand, 2011, 90(5)：421-428.
[26]	Bonnar J. Massive obstetric haemorrhage [J]. Baillieres Best Pract Res Clin Obstet Gynaecol, 2000, 14(1)：1-18.
[27]	Gillissen A, van den Akker T, Caram-Deelder C, et al. Coagulation parameters during the course of severe postpartum hemorrhage: a nationwide retrospective cohort study [J]. Blood Adv, 2018, 2(19)：2433-2442.
[28]	Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum [J]．J Thromb Haemost, 2007, 5(2): 266-273.
[29]	de Lloyd L, Bovington R, Kaye A, et al. Standard haemostatic tests following major obstetric haemorrhage [J]. Int J Obstet Anesth, 2011, 20(2)：135-141.
[30]	Collis RE, Collins PW. Haemostatic management of obstetric haemorrhage [J]. Anaesthesia，2015，70(Suppl1)：78-86.
[31]	徐焕，李笑天. 产后出血的风险评估与预处理[J/CD]. 中华产科急救电子杂志，2017，6(1)：36-38.

入院时高危因素的评估			产程中高危因素的评估
低风险	中风险	高风险	产程中高危因素的评估
单胎妊娠	既往子宫手术史	前置胎盘	第二产程延长
既往阴道分娩次数≤4次	多胎妊娠	红细胞压积<30%	催产素使用时间长
否认凝血障碍	>4次阴道分娩	血小板计数<100×10⁹/L	活动性出血
无产后出血病史	既往产后出血史	入院时有活动性出血	绒毛膜羊膜炎
	子宫肌瘤	已知的凝血障碍	产程中使用硫酸镁
			手术助产(胎吸或产钳)
			胎盘残留

入院时高危因素的评估			产程中高危因素的评估
低风险	中风险	高风险	产程中高危因素的评估
单胎妊娠	既往子宫手术史	前置胎盘	第二产程延长
既往阴道分娩次数≤4次	多胎妊娠	红细胞压积<30%	催产素使用时间长
否认凝血障碍	>4次阴道分娩	血小板计数<100×10⁹/L	活动性出血
无产后出血病史	既往产后出血史	入院时有活动性出血	绒毛膜羊膜炎
	子宫肌瘤	已知的凝血障碍	产程中使用硫酸镁
			手术助产(胎吸或产钳)
			胎盘残留

Please choose a citation manager

Content to export