综述：当前产后出血诊断和管理策略的聚焦回顾：2024年和2025年四项Cochrane系统综述

这篇综述聚焦于2024年和2025年的四项Cochrane系统综述，探讨了产后出血（PPH）的诊断和管理策略。研究发现，校准的血液损失工具结合临床观察在诊断准确性上优于目测估计。多组分实施策略适度提高了对WHO指南的依从性，但对孕产妇死亡率和ICU入院率影响有限。输血和细胞回收策略需进一步验证。推荐临床实践中采用客观测量工具和结构化实施措施以改善PPH护理。

　　

Postpartum hemorrhage (PPH) remains a significant global health concern, particularly in low-resource settings, where it is a leading cause of maternal mortality and severe morbidity. This review synthesizes findings from four Cochrane systematic reviews published in 2024 and 2025, focusing on various aspects of PPH management.

The diagnostic accuracy of tools during vaginal birth was examined, with calibrated blood loss tools combined with clinical observation showing superior performance compared to visual estimation, achieving a pooled sensitivity of 93% and specificity of 95%. This highlights the importance of objective measurement tools in improving diagnostic accuracy.

Implementation strategies for WHO guidelines were also reviewed, with multicomponent strategies modestly improving adherence to WHO-recommended practices. However, these strategies had limited impact on critical outcomes such as maternal mortality and ICU admissions, indicating the need for more effective implementation methods.

The review on transfusion of blood and blood products found that evidence regarding transfusion thresholds, fibrinogen concentrate, and cryoprecipitate was of low certainty and inconclusive. This suggests that current transfusion practices require further validation through high-quality randomized trials to establish more reliable guidelines.

Intraoperative cell salvage during cesarean delivery was another area of focus. The findings indicated potential benefits, including a reduction in total blood loss (mean difference –113.6 mL) and a modest increase in postpartum hemoglobin (mean difference +6.14 g/L). However, the overall quality of evidence remains low, necessitating further research to confirm these benefits.

This review underscores the value of objective measurement tools and structured implementation efforts in improving PPH care. It also highlights the need for further validation of transfusion and salvage practices in high-quality randomized trials. Greater attention should be given to addressing context-specific challenges, particularly in settings with limited resources, to ensure equitable improvements in PPH management worldwide.

Overall, this integrative review provides valuable insights into current PPH management strategies and identifies key areas for future research and clinical practice improvement.