摘要:目的: 分析凶险型前置胎盘的临床特点, 预防产后出血和子宫切除的发生。 方法 :对11例凶险型前置胎盘与75例普通型前置胎盘的病例进行回顾性分析。 结果 :凶险型组与普通型组发生产前出血的量差异无统计学意义(Pgt;0.05);在发生胎盘植入、产后出血的量差异有统计学意义(Plt;0.05);子宫切除的发生率差异有统计学意义(Plt;0.05)。 结论 :凶险型前置胎盘对孕产妇有极大的威胁,应努力做好凶险型前置胎盘产后出血的抢救,减少子宫切除的发生。Abstract: Objective: To assess the clinical feature of dangerous placenta praevia in order to prevent postpartum hemorrhage and intrapartal hysterectomy. Methods : Retrospective analysis was done between the 11 cases of dangerous placenta praevia and ordinary placenta praevia . Results : There were no significant difference in blood volume antepartum (Pgt;0.05); There was significant difference in placenta increta and postpartum hemorrhage (Plt;0.05). Conclusion : Dangerous placenta praevia have great threat to gravid and puerperant, we should try our best to rescue postpartum hemorrhage about dangerous placenta praevia and reduce the incidence of intrapartal hysterectomy.
Objectives To systematically review the efficacy and safety of carbetocinversusoxytocin on the prevention of postpartum hemorrhage (PPH) for women undergoing vaginal delivery. Methods PubMed, The Cochrane Library, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on carbetocinversusoxytocin on the prevention of PPH for women undergoing vaginal delivery from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software. Results A total of 16 RCTs including 2 537 patients were included. The results of meta-analysis showed that: compared to oxytocin, carbetocin could reduce the amount of blood loss within 24h (MD=–107.68, 95%CI–130.21 to –85.15, P<0.000 01) and 2h (MD=–85.98, 95%CI–93.37 to –78.59,P<0.000 01), hemoglobin (Hb) within 24h after delivery (MD=–5.63, 95%CI–6.82 to –4.43,P<0.000 01), the occurrence of PPH (RR=0.46, 95%CI 0.32 to 0.66,P<0.000 01) and the requirement for additional uterotonic agents (RR=0.63, 95%CI 0.48 to 0.84,P=0.002). There was no significant difference in the risk of adverse effects between two groups. Conclusions Current evidence shows that carbetocin is superior to oxytocin in the prevention of PPH for women undergoing vaginal delivery, without increasing the adverse effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above the conclusion.
Objective To systematically review the performance of postpartum hemorrhage risk prediction models, and to provide references for the future construction and application of effective prediction models. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library, Web of Science, and CINAHL databases were electronically searched to identify studies reporting risk prediction models for postpartum hemorrhage from database inception to March 20th, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies. Results A total of 39 studies containing 58 postpartum hemorrhage risk prediction models were enrolled. The area under the curve of 49 models was over 0.7. All but one of the models had a high risk of bias. Conclusion Models for predicting postpartum hemorrhage risk have good predictive performance. Given the lack of internal and external validation, and the differences in study subjects and outcome indicators, the clinical value of the models needs to be further verified. Prospective cohort studies should be conducted using uniform predictor assessment methods and outcome indicators to develop effective prediction models that can be applied to a wider range of populations.
The use of repeated measurement data from patients to improve the classification ability of prediction models is a key methodological issue in the current development of clinical prediction models. This study aims to investigate the statistical modeling approach of the two-stage model in developing prediction models for non-time-varying outcomes using repeated measurement data. Using the prediction of the risk of severe postpartum hemorrhage as a case study, this study presents the implementation process of the two-stage model from various perspectives, including data structure, basic principles, software utilization, and model evaluation, to provide methodological support for clinical investigators.