高龄妊娠产后出血的相关危险因素分析

Analysis of related risk factors for postpartum hemorrhage in women of advanced maternal age

目的采用回顾性研究的方法分析影响高龄产妇产后出血的危险因素,探讨预防和减少产后出血的干预措施,为高龄产妇产后出血的预防和治疗提供参考。方法选取2016年1月~2017年10月在我院生产的产后出血的高龄产妇47例为观察组,并选择同期住院生产的非产后出血的高龄产妇47例为对照组,总结分析两组的临床资料,同时对可能引起产后出血的相关危险因素进行单因素和多因素Logistic回归分析。结果两组产妇年龄、体重指数、孕龄等一般资料比较,差异无统计学意义(P>0.05);两组产妇吸烟史、饮酒史及家族史等一般资料比较,差异无统计学意义(P>0.05);数据显示多次妊娠、妊娠期高血压、前置胎盘、胎盘早剥、胎盘粘连/植入/残留、宫缩乏力、巨大儿、软产道裂伤、凝血功能障碍等因素与产后出血有关联(P<0.05),妊娠期糖尿病、多胎妊娠等因素与产后出血无明显关联(P>0.05);Logistic多因素回归分析,产后出血是多因素共同导致的结果,与产后出血显著相关的危险因素为多次妊娠、妊娠期高血压、前置胎盘、胎盘早剥、胎盘粘连/植入/残留、宫缩乏力和巨大儿。结论多次妊娠、妊娠期高血压、前置胎盘、胎盘早剥、胎盘粘连/植入/残留、宫缩乏力和巨大儿是产后出血的危险因素,医师应重视高危因素的术前诊断、预防与术后处理,从而降低产后出血率。

Objective To analyze the risk factors of postpartum hemorrhage in women of advanced maternal age by using retrospective study methods and to discuss the intervention measures to prevent and reduce postpartum hemorrhage in order to provide reference for the prevention and treatment of postpartum hemorrhage in the women of advanced maternal age. Methods Altogether 47 women of advanced maternal age who underwent delivery and postpartum hemorrhage in our hospital from January 2016 to October 2017 were selected as the observation group; while, another 47 cases of women of advanced maternal age who underwent delivery without postpartum hemorrhage in our hospital during the same period were selected as the control group. The clinical data of two groups of patients were summarized and analyzed, and the risk factors related to postpartum hemorrhage were determined by using single factor and multiple factor Logistic regression analysis. Results There was no statistically significant difference in the general data of age,body mass index and gestational weeks between the two groups（P〉0.05）. There was no statistically significant difference in the general data of smoking history, drinking history and family medical history between two groups（P〉0.05）. It was shown according to the data that factors, such as multiple pregnancy, gestational hypertension（GH）, placenta praevia, placental abruption, placental adhesion/implantation/residue, uterine inertia, macrosomia, laceration of birth canal and coagulation dysfunction, were associated with postpartum hemorrhage（P〈0.05）; factors such as gestational diabetes and multiple pregnancy were not significantly associated with postpartum hemorrhage（P〉0.05）. According to the multiple factor Logistic regression analysis, it indicated that postpartum hemorrhage was the result of multiple factors. The significant risk factors related to postpartum hemorrhage were multiple pregnancy, gestational hypertension, placenta praevia, placental abruption, placental adhesion/implantation/residue, uterine inertia and macrosomia. Conclusion Multiple pregnancy, gestational hypertension, placenta praevia, placental abruption, placental adhesion/implantation/residue, uterine inertia and macrosomia are significant risk factors for postpartum hemorrhage. Doctors and pregnant women should pay attention to preoperative diagnosis, prevention and post-operative treatment of high-risk factors so as to reduce the rate of postpartum hemorrhage.