产钳助产并发产后出血的危险因素分析

The Risk factors of Postpartum Hemorrhage in Forceps Assisted Delivery

目的:探讨产钳助产孕妇并发产后出血的危险因素。方法:回顾性分析2016年1月至2020年12月在北京大学国际医院产科行产钳助产的742例孕妇的临床资料,按照产后24小时出血量分为对照组(产后出血量<500 ml)424例和研究组(产后出血量≥500 ml)318例,其中产后出血量500~1000 ml的为轻微产后出血组,共193例;产后出血量≥1000 ml的为严重产后出血组,共125例。分析3组患者的分娩情况及母儿并发症如子宫颈裂伤、产后尿潴留、新生儿窒息等情况,并采用Logistic回归分析探讨产钳助产并发产后出血的独立危险因素。结果:742例产钳助产孕妇中,产后出血的发生率为42.8%,严重产后出血的发生率为16.8%。与对照组相比,产后出血组的分娩镇痛率、会阴侧切率、子宫颈裂伤率更高,第一产程、第二产程及总产程时长更长(P<0.05),但严重会阴裂伤、产后尿潴留、新生儿窒息率等差异均无统计学意义(P>0.05)。Logistic回归分析显示,年龄、总产程延长及会阴侧切是轻微产后出血的独立危险因素(OR分别为1.059、1.063、2.769,P<0.05);而总产程延长、会阴侧切是导致严重产后出血的独立危险因素(OR分别为1.099和2.056,P<0.05)。结论:总产程延长和会阴侧切与产钳助产并发严重产后出血的发生密切相关。

Objective:To explore the risk factors of postpartum hemorrhage in forceps delivery.Methods:From January 2016 to December 2020,the clinical data of 742 pregnant women who underwent forceps delivery at Peking University International Hospital were retrospectively analyzed.According to the amount of postpartum hemorrhage within 24 hours,they were divided into the control group(424 cases,the amount of postpartum hemorrhage<500 ml),mild postpartum hemorrhage group(193 cases,the amount of postpartum hemorrhage 500-1000 ml),and the severe postpartum hemorrhage group(125 cases,≥1000 ml).Maternal and fetal complications such as cervical laceration,postpartum urinary retention,neonatal asphyxia,et al were analyzed,and binary logistic regression analysis was used to explore the independent risk factors of postpartum hemorrhage in forceps delivery.Results:The incidence of postpartum hemorrhage(≥500 ml)was 42.8%,and the incidence of severe postpartum hemorrhage(≥1000 ml)was 16.8%.Compared with the control group,the labor analgesia rate,perineum lateral incision rate and cervical laceration rate were higher in the postpartum hemorrhage group.The first stage of labor,the second stage of labor and the total labor duration were longer in the postpartum hemorrhage group,but there was no significant difference in the rate of severe perineal laceration,postpartum urinary retention and neonatal asphyxia.Binary logistic regression analysis showed that age,prolonged total labor and episiotomy were independent risk factors for postpartum hemorrhage(≥500 ml)(P<0.05);and prolonged total labor and episiotomy were independent risk factors for severe postpartum hemorrhage(≥1000 ml)(P<0.05).Conclusions:The prolonged total labor time and episiotomy are closely related to severe postpartum hemorrhage.