不同分娩方式对产后出血低危孕妇出血量的影响

Influence of Different Delivery Modes on Postpartum Hemorrhage in Low-risk Women

目的比较不同分娩方式对产后出血低危孕妇出血量的影响。方法对2008年11月1日至2009年10月31日在北京协和医院正规产检足月单胎妊娠分娩产妇进行回顾性分析,排除产后出血高危人群(包括前置胎盘、胎盘早剥、重度子痫前期)。所有入选产妇均于分娩前及产后48h测定血常规,比较剖宫产组与阴道分娩组血红蛋白(he-moglobin,HGB)和红细胞压积(hematocrit,HCT)的变化值,分析影响产后出血量的因素。结果 (1)择期剖宫产组产后HGB下降中位数是-3g/L(-10,-3g/L),HCT下降中位数是-1%(-3.1%,-1.1%);阴道分娩组HGB下降中位数是-8g/L(-17,0g/L),HCT下降中位数是-2.8%(-5.4%,-0.1%)。剖宫产组HGB和HCT差值明显小于阴道分娩组(P=0.000)。(2)阴道分娩组中未行侧切组HGB下降中位数是-2.0g/L(-12.7,4g/L),HCT下降中位数是-1.0%(-3.98%,1.4%),与择期剖宫产组比较差异无统计学意义(P=0.961,0.691)。(3)吸引器助产、会阴侧切、产后刮宫是阴道分娩组产后出血量多的危险因素。结论产后出血低危孕妇,阴道分娩出血量多于剖宫产分娩;导致阴道分娩出血量增加的高危因素包括吸引器助产、会阴侧切和产后刮宫。

Objective To compare the blood loss between vaginal delivery and cesarean section in women at low-risk for postpartum hemorrhage, and to explore the risk factors of postpartum hemorrhage. Method The clinical data of nulliparous women who delivered in Peking Union Medical College Hospital from November 2008 to October 2009 were retrospectively analyzed. Women at high risk for postpartum hemorrhage （including placenta previa, placental abruption, and severe preeclampsia） were excluded. Pre- and post-de- livery hematocrit （HCT） and hemoglobin （HGB） were recorded and compared between the vaginal delivery group and cesarean section group. The ri^k factors associated with postpartum hemorrhage were analyzed. Re- sult After the delivery, the median decrease of HGB and HCT was - 3 g/L （ - 10 g/L- - 3 g/L） and - 1% （ -3.1%- - 1.1% ） , respectively, in the elective cesarean section group, and was -8 g/L （ - 17 g/L-0 g/L） and -2.8% （ -5.4%- -0. 1% ） in the vaginal delivery group （both P 〈 0.05 ）. The median decrease of HGBandHCTwas -2.0g/L （ -12.7 g/L-4 g/L） and -1.0% （-3.98%-1.4%） in theno-episiotomy vaginal delivery group, which was not significantly different from that in the cesarean section group. Forceps,episiotomy, and postpartum curettage were risk factors for postpartum hemorrhage in vaginal delivery group. Conclusions For pregnant women at low risk for postpartum hemorrhage, blood loss during Cesarean section is larger than in vaginal delivery. Forceps, episiotomy, and postpartum curettage are risk factors for postpartum hemorrhage in vaginal delivery group.