孕产妇发生产后出血的相关因素分析

Analysis of related factors of postpartum hemorrhage in pregnant women

目的分析孕产妇发生产后出血(PPH)的相关影响因素。方法将延安市人民医院2015年9月至2017年3月2 038例孕产妇作为研究对象,其中PPH量>500 mL的产妇为PPH组,匹配PPH组产妇一般情况的同期相同数量未发生PPH的产妇为对照组。对PPH的相关因素进行单因素分析,对单因素分析差异有统计学意义的指标纳入logistic多因素回归分析。结果2 038例产妇中,PPH共60例,其发生率为2.94%。单因素分析结果发现,年龄、孕产史、流产史、孕前体质指数(BMI)、胎位不正、胎膜早破、胎盘早剥、宫内窘迫、妊娠期糖尿病(GDM)、妊娠期高血压疾病(HDIP)及新生儿性别等与PPH均无显著相关性(χ^2=1.03、0.76、0.64、0.78、0.01、0.04、0.01、0.02、0.98,均P>0.05),而分娩方式、疤痕子宫、妊娠时限、贫血、胎盘前置、产程情况、胎盘因素及新生儿体质量均与PPH密切相关(χ^2=6.57、7.04、5.89、12.34、7.09、14.07、5.78、6.43,均P<0.05)。非条件logistic多因素回归分析结果发现,影响PPH的相关因素主要有疤痕子宫(OR=6.30,95%CI:3.30~12.02)、产程情况(OR=10.70,95%CI:4.26~26.88)、贫血(OR=6.55,95%CI:1.06~36.77)、胎盘因素(OR=5.53,95%CI:2.73~11.20)和胎盘前置(OR=3.86,95%CI:1.63~9.14)。结论产妇发生PPH是不同影响因素相互作用而引起的,主要危险因素为疤痕子宫、产程延长、贫血、胎盘因素及胎盘前置等,为降低PPH的发生,应针对伴有以上高危因素的产妇及时采取有效、综合性的防范措施。

Objective To analyze the related factors affecting postpartum hemorrhage(PPH) in pregnant women.Methods A total of2 038 parturient women in Yan’an People’s Hospital from September 2015 to March 2017 were studied,and all of them signed informed consent.PPH>500 mL parturient women were in the PPH group,and the same number of parturient women without PPH who matched the general condition of the PPH group were in the control group.Single factor analysis was used to analyze the related factors of PPH,and the logistic regression analysis was used to analyze univariate statistical factors.Results There were 60 cases of PPH in 2 038 cases,with the incidence rate of 2.94%.Single factor analysis showed that the age,history of pregnancy,abortion,BMI in pre-pregnancy,malposition,premature rupture of membranes,placental abruption,MiyamauchiSako and newborn sex showed no significant correlation with postpartum hemorrhage(χ^2=1.03,0.76,0.64,0.78,0.01,0.04,0.01,0.02,0.98,all P>0.05).The delivery methods,uterine scar,pregnancy time,anemia,placenta previa,birth process,neonatal birth weight and placental factors were closely related to postpartum hemorrhage(χ^2=6.57,7.04,5.89,12.34,7.09,21.09,5.78,6.43,all P<0.05).Logistic multivariate regression analysis showed that the uterine scar(OR=6.30,95% CI:3.30 ~ 12.02),prolonged(OR=10.70,95% CI:4.26 ~ 26.88),anemia(OR=6.55,95% CI:1.06 ~ 36.77),placental factors(OR=5.53,95% CI:2.73 ~ 11.20),and placenta previa(OR=3.86,95% CI:1.63 ~9.14) were the main factors of PPH.Conclusion Maternal PPH is caused by the interaction of various factors,so as to reduce the risk of PPH such as uterine scar,prolonged labor,anemia,placenta factor and placenta previa.In order to reduce the risk of PPH,effective and comprehensive preventive measures should be taken in time for parturient women with the above high-risk factors.