年龄>35岁孕妇剖宫产产后出血的发生情况及相关影响因素分析

Prevalence of postpartum hemorrhage in pregnant women over 35 years old after cesarean section and analysis on the related influencing factors

目的调查>35岁孕妇剖宫产产后出血的发生情况,并对其相关影响因素进行分析。方法选取2015年1月-2017年1月在该院行剖宫产的626例>35岁的孕妇为研究对象,统计其产后出血发生情况,以产后是否出血分为出血组(132例)和未出血组(494例),采用单因素和多因素Logistic回归分析>35岁孕妇剖宫产产后出血的影响因素。结果626例>35岁孕妇剖宫产术后产后出血发生率为21.09%(132/626),另有494例未发生产后出血,占比为78.91%;出血组妊娠期高血压史、妊娠期糖尿病史、胎盘粘连、前置胎盘、巨大儿、宫缩乏力占比明显高于未出血组(P<0.05),两组其他指标比较,差异无统计学意义(均P>0.05);多因素Logistic回归分析提示,妊娠期高血压史、胎盘粘连、前置胎盘、巨大儿、宫缩乏力是>35岁孕妇剖宫产产后出血的独立危险因素(P<0.05)。结论高龄剖宫产术后孕产妇产后出血发生率不容忽视,妊娠期高血压史、胎盘粘连、前置胎盘、巨大儿、宫缩乏力孕产妇剖宫产术产后出血的风险更高,临床应据此为高龄剖宫产孕产妇实施合理防治措施。

Objective To investigate the prevalence of postpartum hemorrhage in pregnant women over 35 years old after cesarean section,and analyze the related influencing factors.Methods A total of 626 pregnant women over 35 years old undergoing cesarean section in the First Affiliated Hospital of Chengdu Medical College from January 2015 to January 2017 were selected as study object.The incidence rate of postpartum hemorrhage was statistically analyzed.According to the presence of postpartum hemorrhage,they were divided into bleeding group ( 132 cases) and non - bleeding group ( 494 cases) .The influencing factors of postpartum hemorrhage in pregnant women over 35 years old after cesarean section were analyzed by univariate and multivariate Logistic regression analysis.Results The incidence rate of postpartum hemorrhage in this study was 21.09% ( 132 /626) ,and there were 494 cases without postpartum hemorrhage,accounting for 78.91% ( 494 /626) .The proportions of pregnant women with history of hypertensive disorder complicating pregnancy,gestational diabetes mellitus,placental adhesion,placenta accreta,macrosomia,and uterine inertia in bleeding group were statistically significantly higher than those in non-bleeding group ( P<0.05) ,there was no statistically significant difference in the other indicators between the two groups ( P> 0.05) .Multivariate Logistic regression analysis showed that the history of hypertensive disorder complicating pregnancy,placental adhesion,placenta previa,macrosomia,and uterine inertia were independent risk factors of postpartum hemorrhage in pregnant women over 35 years old after cesarean section ( P<0.05) .Conclusion The incidence rate of postpartum hemorrhage in elderly women after cesarean section can not be ignored.The risk of postpartum hemorrhage is relatively high in women with history of hypertensive disorder complicating pregnancy,placental adhesion,placenta previa,macrosomia,and uterine inertia.Reasonable control measures should be taken accordingly.