前置胎盘导致选择性剖宫产产妇大出血的影响因素分析

Analysis of influencing factors on massive hemorrhage during elective cesarean section in patients with placenta previa

目的探讨前置胎盘导致选择性剖宫产产妇大出血的影响因素。方法选择2004年4月至2014年2月,在延安大学附属医院产科确诊为前置胎盘,并进行选择性剖宫产的105例产妇为研究对象。按照分娩时出血量将其分为大出血（MH）组（n=47,分娩时平均出血量为2 054mL）和非大出血（NMH）组（n=58,分娩时平均出血量为540mL）。对两组产妇的临床病历资料进行回顾性队列调查研究,统计学比较其年龄、人体质量指数（BMI）、产科史、血红蛋白（Hb）含量、孕期舒张压和收缩压等临床指标差异,采用非条件多因素logistic回归分析法,评估前置胎盘导致选择性剖宫产产妇大出血的独立影响因素。本研究所有研究对象均签署书面知情同意书,并获得延安大学附属医院伦理道德委员会的批准。结果 1MH组产妇年龄≥34岁比例及胎盘位于前壁发生率均高于NMH组,而孕期最高舒张压和最高收缩压,则低于NMH组,且上述差异均有统计学意义（P〈0.05）。两组产妇其他12项临床指标,包括BMI、首次生育比例、剖宫产史、其他腹部手术史、子宫肌瘤史、孕前Hb含量、孕期吸烟率、单胎妊娠率、住院治疗率、类固醇使用率、剖宫产前Hb含量及分娩时孕龄比较,差异均无统计学意义（P〉0.05）。2非条件多因素logistic回归分析结果显示：产妇年龄≥34岁（OR=2.09,95%CI：1.16-3.71,P〈0.05）,胎盘位于前壁（OR=2.21,95%CI：1.21-4.03,P〈0.05）是前置胎盘导致选择性剖宫产产妇剖宫产时发生大出血的独立危险因素。结论年龄≥34岁及胎盘位于前壁的前置胎盘产妇,在进行选择性剖宫产时发生大出血的风险较高,应加强防范措施。

Objective To explore the influencing factors of massive hemorrhage during elective caesarean section in pregnant woman with placenta praevia.Methods A total of 105 puerperas who were underwent elective caesarean section with placenta praevia in Obstetrics Department of Yan′an University Affiliated Hospital from April 2004 to February 2014,were chosen as study objects.According to the blood loss volume during elective caesarean section,they were divided into massive hemorrhage（MH）group（n=47,the average blood loss volume was 2 054 mL during elective caesarean section）and non-massive hemorrhage（NMH）group（n=58,the average blood loss volume was 540 mL during elective caesarean section）.Retrospective cohort study was used to research the maternal medical records,and used statistical method to compare the differences between two groups of puerperas in maternal age,body mass index（BMI）,obstetric history,hemoglobin（Hb）content,the highest diastolic and systolic blood pressure during pregnancy etc.,used unconditional multivariate logistic regression analysis to assess the independent factors for massive hemorrhage during elective caesarean section in pregnant woman with placenta praevia.All subjects of this study have signed the informed consent forms,and got the approval of Yan′an University Affiliated Hospital Ethics Committee.Results 1 The proportion of caesarean section maternal age ≥ 34 years old and the incidence rate of placenta located to anterior in MH group were higher than those of NMH group,but the highest diastolic and systolic blood pressure during pregnancy were lower than those of NMH group,and all the differences above were statistically significant（P〈0.05）.There were no significant differences between two groups of elective cesarean section maternal in another 12 clinical indicators left,including BMI,proportion of birth for the first time,the history of cesarean section,other abdominal surgery history,history of uterine fibroids,Hb contents before pregnancy,smoking during pregnancy,singleton pregnancy rate,hospitalization rate,usage rate of steroid,Hb content before cesarean delivery and gestational age at delivery（P〈0.05）.2 Unconditional multivariate logistic regression analysis results showed that maternal age≥ 34 years old（OR=2.09,95%CI：1.16-3.71,P〈0.05）and placenta located to anterior（OR =2.21,95%CI：1.21-4.03,P〈0.05）were independent risk factors of massive hemorrhage during elective caesarean section in pregnant woman with placenta praevia.Conclusions Pregnant women with placenta praevia are more likely to massive hemorrhage during caesarean delivery when age ≥ 34 years old and placenta located to anterior,so preventive measures should be strengthened.