| ObjectivePost-partum haemorrhage (PPH) refers to an estimated blood loss in excess of 500 ml after delivery within 24 hours. It is a serious complications of deliver and the most common causes of maternal mortality. Postpartum hemorrhage (PPH) accounts for 25% of maternal deaths reported by the World Health Organization, it is the first most common cause of maternal mortality in China. The ideal solution for most postpartum hemorrhage is prevention, including Prenatal prevention and Production to take active management during labour. However, so far there are no theories offering prediction to the severity of severe post-partum haemorrhage patients systematically and accurately. The purpose of this study is to establish post-partum haemorrhage prognosis evaluation system to assess the severity of the disease, early prognosis, develop of effective treatment programs to improve the prognosis, and to review information on the new assessment system for evaluation.Methods1. Set 25 indexs(birth place, age,prity, gestational weeks, the number curettage, seized the number of births, uterine scar, medical disease in pregnancy, PLT score, uterine fibroids, pre-eclampsia, placental abruption, placenta previa, palace high, fetal macrosomia, multiple pregnancy, delivery mode, cleft birth canal injury, abnormal first stage of labor, the extension of the second stage of labor, length of third stage of labor, placental adhesion, placenta accreta, stripping bare placenta, uterine atony), and assignment. in accordance with the characteristics of postpartum hemorrhage and risk factors for postpartum hemorrhage and with reference to the classic"post-partum haemorrhage score prediction table"parameter settings, and then assignment.2.a retrospective collection from January 2000 to June 2008 in the third Affiliated Hospital of Guangzhou Medical College (Guangzhou City for treatment of severe maternal Center) obstetric intensive care unit may be 375 cases of complete information on the analysis of data of patients with post-partum haemorrhage, Major haemorrhage is defined as an estimated blood loss of more than 1500 ml. And establish the Postpartum Hemorrhage Prediction scoring system.3. The scores depending on the system were calculated, the relationship between the score and the maternal outcomes (organ dysfunction, hysterectomy and death) were analyzed, And to determine the initial score of the guide clinical treatment, to analyse the forecasting system to guide the clinical treatment of the impact on prognosis from the relationship between score and prognosis .4.Statistical analysis: Results were compared by means of Student's t test ,Mann-Whitney U-test , chi-square test and Fisher's exact test as appropriate , the relationship between the severe preeclampsia -eclampsia scores and multiple organ dysfunction were evaluated by Kruskal-Wallis nonparametric analysis. A multivariate logistic regression model was applied for choosing appropriate variables to the equation of mortality prediction.Results1. New post-partum bleeding score system is composed of 25 variables, including: birth place, age, production times, delivery gestational age, the number curettage, seized the number of births, uterine scar, medical disease in pregnancy, PLT score, uterine leiomyoma, pre-eclampsia, placental abruption, placenta previa, palace high, fetal macrosomia, multiple pregnancy, childbirth methods, canal laceration, abnormal first stage of labor, the extension of the second stage of labor, the third stage of labor, placental adhesion, placenta accreta, fitness stripping the placenta, uterine atony, The score of each variable is 0 to 3 and the maximum possible score is 43. the risk of the prediction formula[0] of Severe postpartum hemorrhage is as follows:log eY / (1-Y) = -7.274 +0.858 * score +0.821 * prenatal postpartum score.2. Retrospective information on postpartum hemorrhage evaluation scoring system from 375cases of patients showed that the more of the score is, the higher of the positive rate of complications [0]and the mother's organ dysfunction is. 2 organ dysfunction: score 4 sub-division, compared with 1-3 significant difference (x~2 =6.23, P =0.01), 3 or more organ dysfunction: sub-12 score compared with the difference between 1-13 division significant (x~2=3.86.1, P=0.02). Score 3 sub-groups: the incidence of cardiac dysfunction was significantly higher (p=0.03), score 7 sub-groups: incidence of the blood system dysfunction than the 1-6 division was significantly higher (x~2=4.35, p=0.02), score Eight sub-groups: renal dysfunction, gastrointestinal system dysfunction than the 1-7 division was significantly higher incidence (p=0.03, x~2=7.64, p=0.006), score 12 Packet: the incidence of breathing, blood, gastrointestinal Road system dysfunction significantly increased, x~2 p value, respectively (x~2 =11.42, p=0.000; x~2=5.62, p=0.018; x~2=5.23, p=0.018), score 13 sub-groups: the incidence of nervous system function disorder significantly increased, x~2 p value, respectively (x~2=26.18, p=0.000), score 14 sub-groups: the incidence of renal function respiratory obstacles than 6-8 division significantly increased (p=0.04). Hysterectomy: Packet 8 incidence compared with the 1-7 packet was significantly higher (x~2 = 9.04, p=0.003). Death: The incidence of sub-20 division compared with 1-7 significantly increased (x~2=7.37, p=0.01). Severe postpartum hemorrhage: 6 sub-score compared with the 1-5 subgroup significantly different (x~2=4.35, P=0.02), score 6-7 Packet compared with 8 Packet significant different (x~2=6.00, p=0.015), sub-12 score compared with the 8-11 division significantly different (x~2=13.18, p=0.000).Conclusions1. We have established the Severe Postpartum Hemorrhage Prediction scoring system and the risk of severe postpartum hemorrhage prediction formula.2. Some information was found usefully for management purposes in Prediction scoring system [0] of Severe Postpartum Hemorrhage. The observations were found that the severe Postpartum Hemorrhage score of 4 is a cutpoint score aiding a management purposes decision regarding [0]that severe Postpartum Hemorrhage patients should be transferred from small hospital to large hospital; the score of 12 is a cutpoint scores aiding management purposes decision regarding which severe Postpartum Hemorrhage patients should be transferred to intensive care unit performing appropriate interventions to reduce the fatality rate. The more of the score is, the higher of the positive rate of severe postpartum hemorrhage. the risk of hysterectomy was significantly increased when the score is more than 8 and should be well prepared[0] for emergency hysterectomy. The risk of maternal mortality was significantly high when the score is more than 20 and early recovery rescue team should prepare to do a good job.3. The evaluation system can effectively predict the risk of severe postpartum hemorrhage , but large sample are needed for further study. |
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