影响前置胎盘剖宫产术后出血的危险因素分析

Analysis of risk factors affecting bleeding after cesarean section of placenta previa

目的:探讨影响前置胎盘产妇剖宫产术后出血的高危因素。方法:回顾性分析行剖宫产术的70例前置胎盘产妇临床资料,分为出血组(产后出血量≥500mL,n=27)与对照组(产后出血量<500mL,n=43)。先对两组各项临床资料实施单因素比较,选取比较结果中存在统计学意义的项目予以非条件Logistic多元逐步回归分析。结果:两组胎数、BMI、本次剖宫产术切口、合并其他妊娠期并发症、宫腔纱布填塞比较均无统计学意义;而高龄、多次宫腔操作、有瘢痕子宫、完全性前置胎盘、合并胎盘粘连或植入、无子宫局部按摩均是导致前置胎盘产妇剖宫产术后出血的独立危险因素。结论:年龄、宫腔操作次数、瘢痕子宫、前置胎盘程度及合并胎盘粘连或植入均可对前置胎盘产妇剖宫产术后出血量产生巨大影响,临床需尽早识别以期改善产妇预后。

Objective To investigate the high-risk factors for bleeding after cesarean section of placenta previa.Methods The clinical data of 70 cases of puerperae with placenta previa undergoing cesarean section were retrospectively analyzed.The puerperae were divided into bleeding group(postpartum bleeding≥500mL,n=27)and control group(postpartum bleeding<500mL,n=43).The clinical data of the two groups were compared by univariate analysis,and then the items with statistical significance in the comparison results were selected for unconditional Logistic multiple stepwise regression analysis.Results There were no significant differences in the number of fetuses,BMI,cesarean section incision,other complications during pregnancy,and uterine gauze packing.Advanced age,multiple intrauterine operations,scarred uterus,total placenta praevia,combined placental adhesions or implantation and without partial uterine massage were independent risk factors for bleeding after cesarean section of puerperae with placenta previa.Conclusions Age,number of intrauterine operations,scarred uterus,placenta previa degree and combined placental adhesion or implantation can have great impacts on the bleeding amount after cesarean section in puerperae with placenta previa.And it is necessary to identify early in clinical application with the aim to improve maternal prognosis.