临床指南
ENGLISH ABSTRACT
产后出血预防与处理指南(2023)
中华医学会妇产科学分会产科学组
中华医学会围产医学分会
作者及单位信息
·
DOI: 10.3760/cma.j.cn112141-20230223-00084
Guidelines for prevention and treatment of postpartum hemorrhage (2023)
Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
Chinese Society of Perinatal Medicine, Chinese Medical Association
Authors Info & Affiliations
Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
Chinese Society of Perinatal Medicine, Chinese Medical Association
·
DOI: 10.3760/cma.j.cn112141-20230223-00084
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摘要

产后出血一直是导致我国孕产妇死亡的首要原因。近20年,我国因产后出血导致的孕产妇死亡虽然已经大幅减少,但仍有进一步下降的空间。产后出血导致孕产妇死亡的主要原因在于诊断和治疗的延迟,错过抢救时机。继2009年《产后出血预防与处理指南(草案)》和2014年《产后出血预防与处理指南(2014)》发布之后,中华医学会妇产科学分会产科学组联合中华医学会围产医学分会基于最新的产后出血研究进展,再次对指南进行修订,对产后出血的病因及高危因素、临床表现及诊断、预防及处理流程进行全面阐述,并提出重要推荐。新版指南强调产后出血处理的“四早原则”——尽早呼救及团队抢救、尽早综合评估及动态监测、尽早针对病因止血和尽早容量复苏及成分输血,避免错过抢救时机而导致孕产妇发生严重并发症甚至死亡。

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中华医学会妇产科学分会产科学组,中华医学会围产医学分会. 产后出血预防与处理指南(2023)[J]. 中华妇产科杂志,2023,58(06):401-409.

DOI:10.3760/cma.j.cn112141-20230223-00084

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产后出血目前仍是我国孕产妇死亡的首要原因。绝大多数产后出血所导致的孕产妇死亡是可避免的1,其关键在于早期诊断和正确处理。中华医学会妇产科学分会产科学组于2009年制定了《产后出血预防与处理指南(草案)》2,并在5年后对其进行更新后发布了《产后出血预防与处理指南(2014)》3。近年来,产后出血的防治又有不少新的研究进展,因此,有必要对该指南进行再次修订。本指南在前述指南的基础上进行修订,主要参考世界卫生组织(WHO)、国际妇产科联盟(FIGO)、美国、英国和加拿大等关于产后出血的诊断与治疗指南以及最新的循证医学证据,并结合国内外有关的临床经验,旨在规范和指导妇产科医师对产后出血的预防和处理。
本指南已在国际实践指南注册与透明化平台(Practice Guidelines Registration For Transparecy)注册(注册号:PREPARE-2022CN683),并成立了指南制定工作组,由指导专家组、制定专家组、方法学专家组等组成,包括全国的多学科专家(产科、助产、麻醉、护理、方法学专家)。指南中重要的临床问题推荐意见的形成过程:指南制定专家组根据PICOS原则[P即研究对象(population),I即干预措施(intervention),C即对照措施(comparison),O即结局(outcome),S即研究类型(study design)]提出临床问题,方法学专家组进行证据的检索、合成和质量分级,基于推荐意见分级评估、制定和评价(Grading of Recommendations Assessment,Development and Evaluation,GRADE)方法形成推荐级别(“强推荐”和“弱推荐”),通过德尔菲专家共识问卷调查达成共识,形成最终的推荐意见。
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备注信息
A
刘兴会,四川大学华西第二医院产科,成都 610041,Email:mocdef.3ab61uiliuhgnix
B
杨慧霞,北京大学第一医院产科,北京 100034,Email:nc.defudabe.umjbaixiuhgnay
C
段涛,同济大学附属第一妇婴保健院产科,上海 201204,Email:mocdef.6ab21oatnaudrd
D

国际实践指南注册与透明化平台,PREPARE-2022CN683

E
中华医学会妇产科学分会产科学组, 中华医学会围产医学分会. 产后出血预防与处理指南(2023)[J]. 中华妇产科杂志, 2023, 58(6): 401-409. DOI: 10.3760/cma.j.cn112141-20230223-00084.
F
所有作者声明无利益冲突
G
国家重点研发计划 (2021YFC2701503)
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