产后出血相关因素分析

Study on risk factors associated with postpartum hemorrhage.

目的 分析与产后出血相关的因素 ,提出合理的防治措施。方法 以 2 0 0 2年 1月 1日至 1 2月 31日在中国福利会国际和平妇幼保健院分娩的产妇 6 1 94例作为观察对象 ,将胎儿娩出后 2h内出血量达到或超过4 0 0mL ,或胎儿娩出后 2 4h内出血量达到或超过 5 0 0mL定义为产后出血 ,采用容积法 +称重法测量产后出血量。通过非条件Logistic回归分析筛选出与产后出血相关的主要危险因素。结果 在 6 1 94例分娩数中 ,符合产后出血的有 77例 ,占 1 2 4 %,单因素分析中有 1 0个因素有统计学意义 ,多因素分析中有 7个因素进入多因素回归模型 ,分别为子宫收缩乏力 (OR =999 0 0 0 ) ,前置胎盘 (OR =4 0 0 73) ,胎盘粘连植入残留 (OR =2 8 5 32 ) ,产道损伤(OR =1 5 1 90 ) ,胎次 (OR =5 5 2 3) ,剖宫产 (OR =3 882 ) ,早接触早吸吮 (OR =0 0 6 9)。结论 加强孕前宣教及孕期管理、严格掌握剖宫产指征、提高医务人员助产技术、同时提倡早接触早吸吮对于降低产后出血及孕产妇死亡起着重要的作用。

Objective To investigate the factors associated with postpartum hemorrhage.Methods There were 6194 deliveries in 2002 in our hospital.Postpartum hemorrhage was defined as blood loss ≥400mL within the first 2 hours or ≥500mL during 24 hours after labor.The amount of blood loss was measured by the method of weight,volume and range estimation.Results 77 cases of postpartum hemorrhage were identified among 6194 deliveries,the incidence of postpartum hemorrhage being 1 24%.There were 10 factors associated with postpartum hemorrhage significantly according to single-factor analysis and 7 factors entered last regression model according to multi-factor analysis.They were uterine inertia(OR=999\^000),placenta previa(OR=40\^073),adherence implantation or residual of placenta(OR=28\^532),birth canal laceration(OR=15\^1%),para(OR=5\^523),cesarean section(OR=3\^882),sucking as early as possible(OR=0\^069).Conclusion It is important to emphasize health education and prenatal management.In the meantime,how to control the rate of C-section and enhance obstetrical assistance skills is important as well for decreasing the incidence of postpartum hemorrhage and pregnancy mortality.