产后出血的评估与高危因素分析

Evaluation and analysis on risk factors of postpartum hemorrhage

目的：分析产后出血（ PPH）的发生率、高危因素及防治方法,为改进PPH的防治措施提供临床资料。方法：通过回顾性病例调查研究调阅2002年1~12月、2007年9月至2008年5月、2012年1~12月3个时间段住院分娩产妇病历,等距随机抽样选300份、596份、598份（分别为A组、B组、C组）,分析PPH及严重PPH（SPPH）发生率、分娩前后血红蛋白（Hb）水平、PPH的高危因素、药物及手术止血方法的应用。结果：以常规方法估算出血量,3组间阴道分娩PPH及SPPH发生率、剖宫产术分娩PPH及SPPH发生率差异均无统计学意义（P〉0.05）；B组剖宫产术分娩PPH发生率高于阴道分娩（P〈0.05）；A、C组内不同分娩方式的PPH及SPPH发生率差异均无统计学意义（P〉0.05）；3组剖宫产术分娩出血量均高于阴道分娩（P〈0.01）。以分娩后48 h的Hb下降值估算出血量,3组PPH发生率均高于常规方法估算出血量时的发生率（P〈0.01）；C组剖宫产术分娩PPH及SPPH发生率均低于B组（P〈0.05）；C组剖宫产术分娩PPH的发生率低于阴道分娩（P〈0.05）。常规方法估算产后出血量与Hb下降值均呈正相关关系（P〈0.01）。 C组剖宫产术分娩发生SPPH者剖宫产指征第一、二顺位分别为前置胎盘和巨大儿。结论：常规方法估算产后出血量明显偏低,有效及时估算出血量的方法有待改进。胎盘因素、巨大儿导致的剖宫产术中SPPH发生呈上升趋势,降低不合理的剖宫产率及加强孕期保健有助于防治PPH。

Objective：To analyze the incidence,risk factors and preventive treatment of postpartum hemorrhage（PPH） for providing the clinical data in improving the prevention measures of PPH. Methods：The data of pregnant women from January to December 2002, from September 2007 to May 2008 and from January to December 2012 were retrospectively analyzed. The 300 cases（group A）,596 cases（group B） and 598 cases（group C） from three corresponding time period were selected by systematic random sampling. The incidence of PPH and severe PPH （ SPPH ） , hemoglobin （ Hb ） before and after delivery, risk factors of PPH, drug and hemostasis between three groups were analyzed. Results：The differences of the incidence of PPH and SPPH between the patients with vaginal delivery and cesarean delivery were not statistically significant（P〉0. 05）. The incidence of PPH in patients with cesarean delivery in group B was higher than that in patients with vaginal delivery（P〈0. 05）. The differences of the incidence of PPH and SPPH between group A and C through different delivery methods cesarean delivery were not statistically significant（P〉0. 05）. The amount of bleeding in 3 groups with cesarean delivery was higher than that in vaginal delivery（P 〈0. 01）. The incidences of the amount of bleeding estimated by the Hb value after 48h of delivery in 3 groups were higher than that in the amount of bleeding estimated by conventional methods （P〈0. 01）. The incidences of PPH and SPPH in group C were lower than that in group B（P〈0. 05）. The incidence of PPH in group C with cesarean delivery was lower than that in group C with vaginal delivery（P 〈0. 05）. The amount of postpartum hemorrhage estimated by conventional methods was positively correlated with the decreasing level of Hb（P〈0. 01）. The placenta previa and macrosomia were the first and second cis-position of cesarean section indications in group C with SPPH. Conclusions：The amount of bleeding estimated by traditional method is low,the effective and timely method should be used to estimate the amount of bleeding. The trend of placenta previa and macrosomia can lead to the SPPH. Reducing the unreasonable cesarean section and inproving health care during pregnancy can help to reduce the PPH.