产后出血高危因素分布及出血原因分析

Risk Factors and Causes of Postpartum Hemorrhage

目的分析本院近3年产后出血高危因素分布特点和出血原因。方法从2014年1月—2016年12月在本院住院分娩的产妇中选取产后出血的116例纳入观察组,另取同期无产后出血的116例为对照组。收集产妇一般情况、本次妊娠情况、分娩情况的相关资料,采用称重法测定观察组产后2 h和24 h的出血量。结果观察组产妇中合并流产史、年龄≥35岁、胎盘粘连或植入、妊娠期高血压、妊娠期胆汁淤积、子宫发育不良、多胎妊娠、羊水过多、巨大儿、凝血功能障碍的比例均高于对照组,差异有统计学意义(P<0.05);组内分析显示,产后出血高危因素中合并流产史比例最高,其次为年龄≥35岁、胎盘前置、妊娠期高血压。116例产后出血患者中剖宫产76例、阴道分娩40例,剖宫产产后平均出血量高于阴道分娩,差异有统计学意义(P<0.01)。子宫收缩乏力是产后出血的主要原因,所占比例高于胎盘因素、软产道损伤、凝血功能障碍,差异有统计学意义(P<0.05)。产后2 h内发生产后出血的患者比例高于产后2～24 h,差异有显著统计学意义(P<0.01);胎盘因素导致的产后出血量高于子宫收缩乏力、软产道损伤、凝血功能障碍,差异有统计学意义(P<0.05)。结论合并流产史、年龄≥35岁、胎盘前置、妊娠期高血压是产后出血的主要高危因素,子宫收缩乏力为产后出血的主要原因。

Objective To analyze the distribution and risk factors of high risk factors of postpartum hemorrhage in recent 3 years in our hospital. Methods From January 2014 to December 2016, 116 cases of postpartum hemorrhage were included in the observation group, and 116 cases without postpartum hemorrhage in the same period were taken as the control group. The related data of maternal general condition, pregnancy and delivery were collected. The bleeding volume of 2 h and 24 h in the observation group was measured by weighing method. Results In the observation group, the incidence of abortion history, age over 35 years, placental adhesion or implantation, pregnancy hypertension, pregnancy cholestasis, dysplasia of uterus, multiple pregnancy, amniotic fluid, macrosomia, coagulation dysfunction were significantly higher than those in the control group（P〈0.05）. The most frequent risk factor for postpartum hemorrhage was the history of combined abortion, followed by age over 35 years old, placenta previa and hypertensive disorder complicating pregnancy. There were 76 cases of cesarean section and 40 cases of vaginal delivery in 116 cases of postpartum hemorrhage. The average amount of bleeding after cesarean section was significantly higher than that of vaginal delivery（P〈0.01）. Uterine inertia was the main cause of postpartum hemorrhage, the proportion of which was significantly higher than that of placenta factor, soft birth canal injury and coagulation dysfunction（P〈0.05）. The proportion of postpartum hemorrhage in postpartum 2 h was significantly higher than that of postpartum 2-24 h（P〈0.01）, and the amount of postpartum hemorrhage caused by placental factors was significantly higher than that of uterine inertia, soft birth canal injury and coagulation dysfunction（P〈0.05）. Conclusion The history of abortion, age more than 35 years, placenta previa, pregnancy induced hypertension are the main risk factors of postpartum hemorrhage. Uterine inertia is the main cause of postpartum hemorrhage.