产后出血的重新评估

Re-estimation of postpartum hemorrhage.

目的 准确估计产后出血量 ,了解产后出血量与生命体征、血红蛋白及红细胞压积间的关系。方法 应用客观测定法 (称重法、容积法、羊水压积测定法 )和主观测定法 (目测法 )测量自然分娩和剖宫产妇女的产后出血量 ,同时测定产前、产时和产后血压、心率、血红蛋白和红细胞压积。结果 ①自然分娩组产妇平均出血量为( 3 62 2 5± 186 91)mL ,95 %可信性为 710 0 1mL。剖宫产组平均出血量为 ( 5 2 7 77± 3 0 4 15 )mL ,95 %可信性为10 3 4 4 2mL。②目测法测量自然分娩组平均产后出血量 ( 176 4 4± 5 7 71)mL ,仅为客观测量法的 4 8 71% ,剖宫产组平均产后出血量 ( 2 5 4 0 4± 115 61)mL ,仅为客观测量法的 4 8 13 %。③临产前、临产后、第二产程、第三产程、产后 3 0、60和 12 0min两组产妇血压、心率、血红蛋白和红细胞压积均无明显差异。结论 阴道分娩和剖宫产分娩的产后出血量可以区别定义。目前临床目测法估计产后出血量较实际出血量减少 5 0 %。机体充足的代偿功能使产妇出血量在 10 0 0mL内生命体征稳定 ,血红蛋白和红细胞压积无明显改变。

Objective To estimate the amount of postpartum hemorrhage accurately and to investigate the relationship between the amount of postpartum hemorrhage and vital signs?hemoglobin(Hb)and hematocrit(HCT).Methods The amount of postpartum hemorrhage in groups of vaginal delivery and cesarean section was determined with objective methods of weight,volume,HCT in amniotic fluid and subjective method(range estimation).Blood pressure(BP),heart rate(HR),Hb and HCT were determined at antepartum,intrapartum and postpartum.Results ①The average amount of postpartum hemorrhage was 326 25±186 91mL,and the 95% confidence limit was 710 01mL in group of vaginal delivery.The average amount of postpartum hemorrhage was 527 77±304 15mL and the 95% confidence limit was 1034 42mL in groups of cesarean section.②By subjective method,the average amount of postpartum hemorrhage in vaginal delivery group was 176 44±57 71mL (only 48\^71% of the amount detected by objective method),and that in cesarean section group was 254 04±115 61mL(48\^13% of that by objective method).③No significant difference was found on BP,HR,Hb and HCT at antepartum,intrapartum and postpartum 30min,60min,and 120min.Conclusion The definition of postpartum hemorrhage between groups of vaginal delivery and cesarean section may be different.The amount of postpartum hemorrhage with method of range estimation is half of real amount. The parturient women show no obvious change of vital signs,Hb and HCT if the amount of postpartum hemorrhage is less than 1000mL.