胎盘前置状态引产出血的危险因素分析

Risk factors of bleeding in termination of pregnancy with placenta previa

目的分析胎盘前置状态引产出血的危险因素,为预防引产出血提供参考。方法纳入2016年2月至2018年7月761例孕10~26周合并胎盘前置状态引产的患者761例,按患者引产方式的不同分为药物引产组和依沙吖啶引产组,分别收集患者年龄、孕次、产次、前次生育方式、孕周、胎儿因素、胎盘娩出情况、胎盘位置、胎盘及宫颈内口距离等临床资料,回顾性分析以上因素与引产出血量的相关性。结果在395例孕10~16周的药物引产组中,胎盘粘连[比值比(odds ratio,OR)=5.21]是引产出血的主要危险性因素,胎盘和宫颈内口距离(OR=0.65)是引产出血的保护性因素,即胎盘距离越远越安全。在366例孕16~26周依沙吖啶引产组中,引产出血的危险性因素依次是胎盘粘连(OR=2.43)、剖宫产(OR=2.37)及孕周(OR=1.43),胎盘和宫颈内口距离(OR=0.75)是引产出血的保护性因素。结论胎盘前置状态引产术前应充分评估患者的各项危险性因素,特别是可能合并胎盘粘连的患者,对减少引产出血的发生具有重要意义。

Objective Analyze the risk factors of bleeding in termination of pregnancy with placenta previa to provide references for the prevention of postpartum hemorrhage.Methods From February 2016 to July 2018,a total of 761 cases with placenta previa induced labor during 10~26 weeks of pregnancy were included.According to the different ways of induced labor,they were divided into drug induced labor group and ethacridine induced labor injection group,to collect the clinical data of age,gestational times,birth times,previous birth mode,gestational weeks,fetal factors,placental delivery,placental position,distance between placenta and cervix,and analyze the correlation between the above factors and induced postpartum bleeding.Results In 395 patients with drug induction group at 10~16 weeks of gestation,placenta adhesion[odds ratio(OR)=5.21]is a major risk factor of postpartum bleeding,the distance between the lower margin of placenta and the internal orifice of the cervix(OR=0.65)is the protective factor of induced postpartum bleeding,that is,the farther the placenta is,the safer it is.In 366 patients with the group ofinduced labor with ethacridine at 16~26 weeks of gestation,the risk factors of postpartum bleeding was followed by the placenta adhesion(OR=2.43),previous history of cesarean section(OR=2.37),gestational age(OR=1.43),the distance between the lower margin of placenta and the internal orifice of the cervix(OR=0.75)is the protective factor of induced postpartum bleeding.Conclusion It is important to evaluate the risk factors of patients with placental previa before induced labor,especially for patients with placental adhesion to reduce the postpartum bleeding.