中林正雄，朝倉啓文，久保隆彦，他：わが国の周産期センターにおける妊産婦死亡の分析と防止対策．日産婦誌 2007; 59; 1222-1224(III)．.
日本産科婦人科学会／日本産婦人科医会：産婦人科診療ガイドライン産科編2023.
2008年日本産科婦人科学会周産期委員会調査結果．周産期委員会報告2009年61巻7号．.
Ohkuchi A, Onagawa T, Usui R, Koike T, Hiratsuka M, Izumi A, Ohkusa T, Matsubara S, Sato I, Suzuki M, Minakami H.
Effect of maternal age on blood loss during parturition: a retrospective multivariate analysis of 10,053 cases.
J Perinat Med. 2003;31(3):209-15. doi: 10.1515/JPM.2003.028.
Abstract/Text
OBJECTIVE: An extensive study as to whether maternal age itself is a risk factor for blood loss during parturition.
METHOD: A total of 10,053 consecutive women who delivered a singleton infant were studied. The excess blood loss was defined separately for women with vaginal and cesarean deliveries as > or = 90th centile value for each delivery mode. The effects of 13 potential risk factors on blood loss were analyzed using multivariate analysis.
RESULTS: The 90th centile value of blood loss was 615 ml and 1,531 ml for women with vaginal and cesarean deliveries, respectively. A low lying placenta (odds ratio [OR], 4.4), previous cesarean (3.1), operative delivery (2.6), leiomyoma (1.9), primiparity (1.6), and maternal age > or = 35 years (1.5) were significant independent risk factors for excess blood loss in women with vaginal delivery. Placenta previa (6.3), leiomyoma (3.6), low lying placenta (3.3), and maternal age > or = 35 years (1.8) were significant independent risk factors for excess blood loss in women with cesarean sections.
CONCLUSION: A maternal age of > or = 35 years was an independent risk factor for excess blood loss irrespective of the mode of delivery, even after adjusting for age-related complications such as leiomyoma, placenta previa, and low lying placenta.
American College of Obstetricians and Gynecologists.
ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage.
Obstet Gynecol. 2006 Oct;108(4):1039-47. doi: 10.1097/00006250-200610000-00046.
Abstract/Text
Severe bleeding is the single most significant cause of maternal death world-wide. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding. It is estimated that worldwide, 140,000 women die of postpartum hemorrhage each year-one every 4 minutes (1). In addition to death, serious morbidity may follow postpartum hemorrhage. Sequelae include adult respiratory distress syndrome, coagulopathy, shock, loss of fertility, and pituitary necrosis (Sheehan syndrome). Although many risk factors have been associated with postpartum hemorrhage, it often occurs without warning. All obstetric units and practitioners must have the facilities, personnel, and equipment in place to manage this emergency properly. Clinical drills to enhance the management of maternal hemorrhage have been recommended by the Joint Commission on Accreditation of Healthcare Organizations (2). The purpose of this bulletin is to review the etiology, evaluation, and management of postpartum hemorrhage.
日本産科婦人科学会、日本産婦人科医会編：産婦人科診療ガイドライン産科編2017、2017.
日本産婦人科医会：分娩周辺期の救急．日本産婦人科医会研修ノート 2009; 82: 17-46．.
日本麻酔科学会編：麻酔薬および麻酔関連薬使用のガイドライン 第3版、2009.
日本産婦人科医会 研修ノートNo.103 産科異常出血への対応、2020.
日本麻酔科学会、日本輸血・細胞治療学会編：危機的出血への対応ガイドライン、2007.
日本産科婦人科学会、日本産婦人科医会編：産婦人科診療ガイドライン産科編2023、2023.
日本産科婦人科学会、日本産婦人科医会編：産婦人科診療ガイドライン産科編2020、2020.
.
Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.
Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891.
Abstract/Text
Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. It has been estimated that preeclampsia complicates 2-8% of pregnancies globally (). In Latin America and the Caribbean, hypertensive disorders are responsible for almost 26% of maternal deaths, whereas in Africa and Asia they contribute to 9% of deaths. Although maternal mortality is much lower in high-income countries than in developing countries, 16% of maternal deaths can be attributed to hypertensive disorders (). In the United States, the rate of preeclampsia increased by 25% between 1987 and 2004 (). Moreover, in comparison with women giving birth in 1980, those giving birth in 2003 were at 6.7-fold increased risk of severe preeclampsia (). This complication is costly: one study reported that in 2012 in the United States, the estimated cost of preeclampsia within the first 12 months of delivery was $2.18 billion ($1.03 billion for women and $1.15 billion for infants), which was disproportionately borne by premature births (). This Practice Bulletin will provide guidelines for the diagnosis and management of gestational hypertension and preeclampsia.
Mattar F, Sibai BM.
Eclampsia. VIII. Risk factors for maternal morbidity.
Am J Obstet Gynecol. 2000 Feb;182(2):307-12. doi: 10.1016/s0002-9378(00)70216-x.
Abstract/Text
OBJECTIVE: This study was undertaken to identify risk factors associated with adverse maternal outcome in pregnancies complicated by eclampsia.
STUDY DESIGN: This was a descriptive study of 399 consecutive women with eclampsia whose cases were managed at one perinatal center between August 1977 and July 1998. Data were collected. Risk factors studied included maternal age, race, parity, preexisting medical complications, and clinical and laboratory findings. Outcome variables were maternal morbidities. Data were analyzed by either chi(2) analysis or the unpaired Student t test as appropriate.
RESULTS: In the entire cohort of women with eclampsia major maternal complications included abruptio placentae (10%), HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome (11%), disseminated intravascular coagulopathy (6%), neurologic deficits and aspiration pneumonia (7%), pulmonary edema (5%), cardiopulmonary arrest (4%), acute renal failure (4%), and death (1%, n = 2 patients with antepartum onset). Women with antepartum eclampsia had significantly higher incidences of abruptio placentae (12% vs 6%; P <.05) and HELLP syndrome (14% vs 4%; P =. 005) than did those in whom eclampsia developed post partum. In contrast, women with postpartum eclampsia were more likely to have neurologic deficits develop (9% vs 2%; P =.0006) than were those with antepartum eclampsia. In addition, women in whom eclampsia developed at CONCLUSION: Eclampsia remains a significant complication of pregnancy that carries high maternal mortality and morbidity rates. Antepartum onset carries greater risks, and onset at
