全面二孩政策实施前后黔北地区产后出血患者流行病学特点及其入ICU影响因素的单中心研究

Epidemiological Characteristics of Patients with Postpartum Hemorrhage in Northern Guizhou before and after the Implementation of Comprehensive Two-child Policy and Its Influencing Factors in ICU Admission:a Single-center Study

背景 随着全面二孩政策的实施,高龄和危重病产妇近年来有明显增加的趋势,所以分析患者产后出血的高危因素及入ICU原因,是非常有必要的,其能有效预防产后出血的发生和随之带来的一系列危害,进而降低产后出血的发生率.目的 了解全面二孩政策实施前后黔北地区产妇产后出血的流行病学特点,探寻其入ICU的影响因素.方法 回顾性分析遵义医学院附属医院2014年1月-2017年12月961例产后出血患者的临床资料,以全面实施二孩政策时间(2016-01-01)为节点,分为全面二孩政策实施前(2014年1月-2015年12月),全面二孩政策实施后(2016年1月-2017年12月).收集全面二孩政策实施前后患者临床特征,包括年龄、高龄(≥35岁)、孕次、产次、分娩孕周、定期产检情况、瘢痕子宫、分娩方式、胎数、妊娠期高血压发病情况、前置胎盘、胎盘粘连/植入、新生儿体质量、输血情况、子宫切除、介入治疗、单纯药物治疗、入ICU、出血量、死亡及主要出血原因.入ICU影响因素探讨采用多因素Logistic回归分析.结果 全面二孩政策实施后产妇产后出血发生率高于全面二孩政策实施前(P=0.029);全面二孩政策实施前后患者年龄、高龄情况、孕次、产次、瘢痕子宫、分娩方式、妊娠期高血压发病率、胎盘粘连/植入情况、入ICU情况、出血量、子宫收缩乏力发生率比较,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示瘢痕子宫〔OR=3.064,95%CI(1.877,5.033),P<0.001〕、妊娠期高血压〔OR=3.107,95%CI(1.721,5.608),P<0.001〕、前置胎盘〔OR=1.901,95%CI(1.155,3.128),P=0.011〕、妊娠期肝损伤〔OR=14.718,95%CI(2.998,72.260),P=0.001〕和妊娠期合并心脏病〔OR=20.535,95%CI(4.419,95.434),P<0.001〕是产妇产后出血患者入ICU的影响因素.结论 全面二孩政策实施后,产后出血发生率明显上升,高龄、妊娠期高血压、瘢痕子宫和胎盘粘连/植入是产妇产后出血的高危因素,瘢痕子宫、妊娠期高血压、前置胎盘、妊娠期合并肝损伤和妊娠期合并心脏病是产后出血产妇进入ICU的危险因素.

Background With the implementation of the comprehensive two-child policy,the number of advanced age and critically ill parturient women have a significant increase in recent years,so it is very necessary to analyze the high risk factors of postpartum hemorrhage and the risk factors associated with ICU admission.It can effectively prevent the occurrence of postpartum hemorrhage and the resulting series of harms,thereby reducing the incidence of postpartum hemorrhage.Objective To investigate the epidemiological characteristics of postpartum hemorrhage in pregnant women before and after the implementation of the comprehensive two-child policy in the north area of Guizhou province,and to further analyze the risk factors associated with ICU admission in pregnant women with postpartum hemorrhage.Methods Taking the implementation of the comprehensive two-child policy on January 1,2016 as the time point,clinical data of patients with postpartum hemorrhage(961 cases)admitted to Affiliated Hospital of Zunyi Medical College during the comprehensive policy implementation time point were collected and retrospectively analyzed.Postpartum hemorrhage patients were compared before implementation(January 2014 to December 2015)and after the implementation(January 2016 to December 2017).Clinical characteristics of patients before and after the implementation of the comprehensive two-child policy were collected,including age,senior age(≥35 years),maternal delivery,gestational weeks of delivery,regular checkups,scar uterus,mode of delivery,number of fetuses,incidence of hypertension during pregnancy,placenta previa,placenta adhesion/implantation,neonatal body weight,blood transfusion,hysterectomy,interventional therapy,drug therapy alone,ICU admission,bleeding volume,death and major bleeding causes.Multivariate Logistic regression analysis were used to identify possible factors affecting ICU admission.Results After the implementation of the comprehensive two-child policy,the incidence of postpartum hemorrhage was significantly increased(P=0.029);further comparison of clinical data of patients with postpartum hemorrhage found that after the implementation of the comprehensive policy,maternal age and advanced age,gestational times,delivery times,scar uterus,cesarean section,hypertensive disorder complicating pregnancy,placental adhesion/implantation,ICU admission and bleeding volume and uterine contraction in the ICU increased significantly(P<0.05).Multiple Logistic regression showed that scar uterus〔OR=3.064,95%CI(1.877,5.033),P<0.001〕,hypertensive disorder complicating pregnancy〔OR=3.107,95%CI(1.721,5.608),P<0.001〕,placenta previa〔OR=1.901,95%CI(1.155,3.128),P=0.011〕,liver damage during pregnancy〔OR=14.718,95%CI(2.998,72.260),P=0.001〕and combination with heart disease during pregnancy〔OR=20.535,95%CI(4.419,95.434),P<0.001〕were independent risk factors of ICU admission in patients with postpartum hemorrhage.Conclusion After the implementation of the comprehensive two-child policy,the incidence of postpartum hemorrhage has increased in the north area of Guizhou province.Advanced age,hypertensive disorder complicating pregnancy,scar uterus and placental adhesion/implantation are risk factors for postpartum hemorrhage;scar uterus,hypertensive disorder complicating pregnancy,placenta previa,pregnancy with heart disease and pregnancy with hepatic dysfunction are independent risk factors for ICU admission in postpartum hemorrhage.