BACKGROUND Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome. METHODS Women with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks' gestation or occurring up to 42 days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of ≥5 units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death. RESULTS The incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14]. CONCLUSIONS Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.

中文翻译：

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南非开普敦大都会东区的重大产科出血：使用孕产妇未遂方法进行的基于人群的队列研究。

背景技术严重的产科出血是孕产妇死亡的主要原因，占非洲孕产妇死亡的三分之一。这项研究旨在评估以人群为基础的发病率，主要产科出血的病因，治疗和转归以及与不良母体结局相关的危险因素。方法从2014年11月至2015年11月，对符合WHO孕产妇未命中标准或在南非开普敦大都会东部地区死亡的重度产科出血妇女进行评估。重度产科出血定义为至少怀孕的出血妊娠20周或出生后长达42天，并导致子宫切除术，血容量减少性休克或输血≥5个单位的堆积红细胞。使用Logistic回归模型分析结果差的关联，定义为导致大量输血≥8个单位的大量红细胞输血，子宫切除术或死亡的重大产科出血。结果在大都会东部地区，重大产科出血的发生率为3/1000例，大量输血的发生率为4 / 10.000例（在研究期间内发生了32.862例）。出血的主要原因是胎盘早剥45/119（37.8％），剖宫产29/119并发症（24.4％）和子宫收缩乏力13/119（10.9％）。98/119名妇女（82.4％）给予催产素治疗，33/119名妇女（27.7％）进行子宫切除术。包装的红细胞和新鲜冷冻血浆输注的中位数为6（四分位间距4-7）和3（四分位间距2-4），比例为1.7：1。剖腹产与不良的产妇结局独立相关：调整后的OR为4.01 [95％CI 1.58，10.14]。结论使用产妇近小姐法评估重度产科出血表明，胎盘早剥和剖宫产并发症是重度产科出血的主要原因。剖宫产与预后不良有关。