妊娠期不同时段凝血功能变化与产后异常出血的相关性研究

Correlation between the changes of coagulation function in different periods of pregnancy and abnormal postpartum hemorrhage

目的:探讨妊娠期不同时段凝血功能变化与产后异常出血的关系。方法:选取医院2018年3月至2020年4月分娩的58例产后异常出血产妇资料,纳为异常出血组,另收集同期分娩的57例无产后异常出血产妇资料,纳为无异常出血组。统计并比较产妇孕早期、中期、晚期凝血功能相关指标[纤维蛋白原(Fibrinogen,FIB)、凝血酶时间(Thrombin time,TT)、活化部分凝血酶时间(Activated partial thromboplastin time,APTT)、凝血酶原时间(Prothrombin time,PT)]变化情况,分析产妇凝血功能变化与产后异常出血的关系。结果:与妊娠早期相比,两组FIB水平逐渐升高,APTT、PT水平逐渐降低,但异常出血组各时间点FIB水平低于无异常出血组,APTT、PT水平均高于无异常出血组(P<0.05);经回归分析显示,妊娠至孕晚期FIB降低、APTT与PT升高可能是产妇产后异常出血的风险因子(OR>1,P<0.05);绘制受试者工作曲线发现,妊娠晚期FIB、APTT、PT预测产后异常出血风险价值-曲线下面积均>0.80,有一定预测价值。结论:产妇妊娠期不同时段凝血功能变化与产后异常出血有关。

Objective:To investigate the relationship between the changes of coagulation function in different periods of pregnancy and abnormal postpartum hemorrhage.Methods:Retrospectively analyzed,the data of 58 pregnant women with abnormal postpartum hemorrhage who had been established cards and delivered from March 2018 to April 2020 in our hospital were collected as the abnormal bleeding group,in addition,the data of 57 pregnant women without abnormal postpartum hemorrhage were collected as the non abnormal bleeding group;the changes of coagulation related indexes[fibrinogen(FIB),thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT)]of the pregnant women in the early,middle and the third trimester of pregnancy were counted and compared,the relationship between changes of coagulation related indexes and abnormal postpartum hemorrhage in pregnant women was analyzed.Results:Compared with early pregnancy,FIB levels in both groups increased gradually,but FIB levels at each time point in the abnormal bleeding group were lower than those in the non abnormal bleeding group,APTT and PT levels were higher than those in the non abnormal bleeding group(P<0.05).Logistic regression analysis showed that the decrease of FIB,increase of APTT and PT levels from pregnancy to the third trimester of pregnancy might be risk factors of abnormal postpartum hemorrhage in pregnant women(OR>1,P<0.05);the ROC curve was drawn and it is found that the AUC values of FIB,APTT and PT in the third trimester of pregnancy in predicting postpartum hemorrhage were all>0.80,which had certain predictive value.Conclusion:The changes of coagulation function in different periods of pregnancy of pregnant women are related to abnormal postpartum hemorrhage.