产后出血高危因素的三级预防分析

Three Level Prevention of Risk Factors of Postpartum Hemorrhage

目的:从三级预防角度探讨系统预防和减少产后出血的措施。方法:对我院2008年1月至2012年12月住院分娩的产妇产后出血440例,对照组1200例,通过多元Logistic回归分析评价各高危因素的相对风险值。结果:妊娠年龄≥35岁(OR=1.8),孕前体重>62.8 kg(OR=1.4),孕次>3次(OR=1.4),产次>2次(OR=4.3),双胎(OR=2.2),肌瘤剥出史(OR=4.0),这些因素可以于孕前进行一级预防。作为二级预防孕期干预的高危因素有子痫前期及妊娠期高血压(OR值为2.5和1.9)、胎儿各生长径线代表的胎儿预估体重、硫酸镁的应用史(OR=2.8)、产前Hb<108g/L(OR=1.2);产时干预的高危因素为会阴侧切(OR=1.4)、产道裂伤(OR=1.1)、剖宫产(OR=1.2)、第三产程>8分钟(OR=1.1)。结论:减少产后出血高危因素,需要通过孕前孕期产时三级预防完整模式进行综合干预。

Objective： To analyze the risk factors of postpartum hemorrhage in three level prevention,discuss how to prevent and reduce postpartum hemorrhage rates. Methods： Total 440 patients of postpartum hemorrhage in our hospital from 2008 January- 2012 December were recruited as cases and 1200 women of normal labor were randomly selected as controls. Various risk factors were study by multivariate logistic regression analysis.Results： Primary intervention of the risk factors of postpartum hemorrhage were pregnant age≥35 OR 1. 8,pregeatational weight 62. 8 kg OR 1. 4,gravidity 〉3 times and parity 〉2times OR 1. 4 /4. 3,twin pregnancy OR 2. 2,leiomyoma stripping history OR 4. 0; the two level prevention interventions had preeclampsia and gestational hypertension OR 2. 5 /1. 9,diameter of fetal growth,the application history Magnesium sulfate OR 2. 8; Hb 〈108 g / L OR 1. 2; risk factors of three levels of prevention intervention were Lateral episiotomy OR 1. 4,caesarian OR 1. 2,laceration of birth canal OR 1. 1 and third stage of labor 〉8 min OR 1. 1. Conclusions： The decrease of risk factors of postpartum hemorrhage need a complete model of pre-conception-during pregnancy-post delivery tertiary prevention comprehensive intervention.