高龄产妇产后出血直接原因及影响因素

Analysis of the causes and risk factors of postpartum hemorrhage in elderly mothers

目的:调查高龄产妇产后出血直接原因及影响因素。方法:选择2010年1月至2017年5月分娩的高龄产妇150例作为研究对象,调查所有产妇产后出血的发生情况及产妇的临床资料,分析直接病因与影响因素。结果:150例高龄产妇发生产后出血30例,发生率为20.0%;出血量最少522 m L,最多2 421.49 m L,平均出血量为752.92 m L;出血速度为(189.33±2.34)m L/h;出血类型:局灶型15例,弥漫型者11例,不明显型4例。产后出血30例中宫缩乏力12例、剖宫产2例、软产道裂伤5例、凝血功能障碍6例、胎盘因素2例、其他3例。二分类非条件Logistic回归分析显示年龄、产次、受教育年限、分娩方式是影响高龄产妇产后出血的影响因素。在30例产后出血产妇中,采用保守治疗25例、盆腔动脉血管结扎术3例、子宫次全切除1例、子宫全切1例,出血均得到控制,无产妇死亡。结论:高龄产妇产后出血比较常见,主要出血原因为宫缩乏力、剖宫产、软产道裂伤、凝血功能障碍、胎盘因素等,年龄、产次、受教育年限、分娩方式是影响高龄产妇产后出血的主要危险因素,要积极进行对症处理。

Objective： To investigate the causes and risk factors of postpartum hemorrhage in elderly mothers. Methods ：150 elderly mothers who gave birth from January 2010 to May 2017 in our hospital were selected as the research objects. The occurrence of postpartum hemorrhage and the clinical data were investigated to analyze the etiology and risk factors. Results ：There were 30 cases of maternal postpartum hemorrhage, with the incidence rate of 20.0 % ; the least bleeding amount was 522 mL, the most was up to 2421.49mL, and the average bleeding amount was 752.92 mL; the average bleeding rate was 189.33 ± 2.34 mL/h; there were 15 cases of focal type, 11 cases of diffuse type and 4 cases of unknown type. In the 30 cases of maternal postpartum hemorrhage, there were 12 cases of uterine inertia, 2 cases of cesarean section, 5 cases of soft birth laceration, 6 cases of coagulation dysfunction, 2 cases of placental factors and 3 cases of others. Unconditioned Logistic regression analysis showed that age, parity, education period and the mode of delivery were the main risk factors of postpartum hemorrhage in elderly patients. In the 30 cases of postpartum hemorrhage, 17 cases were treated with conservative treatment, 3 cases with pelvic arterial ligation, 1 case with subtotal hysterectomy and 1 case with total hysterectomy, and the bleeding had been controlled without death. Conclusion：Maternal postpartum hemorrhage is more common in the elderly, and the main causes of bleeding are due to uterine inertia, cesarean section, soft birth canal laceration, coagulation dysfunction and placental factors. Age, birth, education, parity and delivery mode are the risk factors of maternal postpartum hemorrhage in elderly, which should be actively symptomatic treated.