晚期产后出血的防治

Prevention and Control of the Late Postpartum Hemorrhage

目的:探讨晚期产后出血的病因及防治要点。方法:对1991年6月至2005年12月治疗的72例晚期产后出血病例进行临床分析。结果:病因以胎盘残留占第一位(32例,44.4%),子宫内膜蜕膜炎占第二位(15例,20.8%),子宫复旧不良占第三位(12例,16.7%),其余是子宫切口愈合不良(7例,9.7%)和产道血肿(6例,8.3%)。导致本症的相关因素有:第三产程处理不当、感染和手术操作问题等。70例经保守治疗痊愈,仅2例切除子宫。结论:本症重在预防,应重视第三产程的处理、合理使用抗生素、提高剖宫产手术质量及会阴伤口缝合技术、加强围产期保健工作等。保守治疗效果良好,仅极少数严重病例需手术治疗甚至切除子宫。

Objective ：our study is to investigate the key points for the pathogenesis prevention and treatment of late postpartum hemorrhage. Methods：72 cases of the late postpartum hemorrhage treated from June, 1999 to December, 2005 were statistically analyzed. Results： The pathogenesis at first place was placenta residue （32 cases, 44.4% ） , the secondary was endometritis （15cases, 20.8% ）, the third was uterus subinvolution （ 12 cases, 16.7% ）, the rest were adverse healing of uterus incision （ 7cases, 9.7% ） and birth canal hematoma （6 cases, 8.3% ）. The factors resulted in this disease were the following： mistreatment of third labor stag, infection and improper operation et al. In our study 70 cases were cured by conservative treatment, while uterus excision was performed only on two patients. Conclusions： The prevention is the most important measure for this disease. Therefore we should strengthen handling of the third labor stage, properly use the antibiotics, improve the quality of the operation on ceasarean section and perineorrhaphy stitch and better the perinatal health care. Conservative treatment is very effective. The operations were carried out only on a few intensive cases. The most serious result is uterus excision.