瘢痕子宫患者产后出血的危险因素及D-二聚体的预测价值分析

Risk factors of postpartum hemorrhage in patients with scar uterus and predictive value of D-dimer

目的探讨瘢痕子宫产妇产后出血的危险因素及D-二聚体对产后出血的预测价值。方法选取2020年1月至12月广东省中西医结合医院和佛山市南海区桂城医院收治的300例瘢痕子宫再次妊娠的产妇作为研究对象。根据是否发生产后出血将产妇分为产后出血组(n=48)和非产后出血组(n=252)。收集两组产妇的基线资料,采用单因素和多因素Logistic回归分析瘢痕子宫产妇产后出血的危险因素,同时分析D-二聚体对产后出血的诊断价值。结果单因素及多因素Logistic回归分析显示,年龄、孕次、刮宫次数、分娩孕周、分娩时宫底高度、新生儿出生体重、妊娠合并症、子宫切口撕裂均是产后出血的危险因素(P<0.05);产前血清D-二聚体水平预测产后出血的曲线下面积为0.850(95%CI:0.796~0.904)。结论瘢痕子宫产妇产后出血的危险因素包括年龄、孕次、刮宫次数、分娩孕周、分娩时宫底高度、新生儿出生体重、妊娠合并症、子宫切口撕裂等,检测产前D-二聚体水平可有效预测产后出血的发生,其可为产后出血的早诊断、早治疗提供参考,从而改善产后出血患者的预后水平。

Objective To investigate the risk factors of postpartum hemorrhage in patients with scar uterus and the predictive value of D-dimer in postpartum hemorrhage.Methods A retrospective study was conducted on 300 cases of pregnant women with scar uterus who were admitted to Guangdong Hospital of Integrated Traditional Chinese and Western Medicine and Guicheng Hospital of Nanhai District,Foshan City from January to December 2020.The pregnant women were divided into postpartum hemorrhage group(n=48)and non-postpartum hemorrhage group(n=252)according to the pregnant women suffered from postpartum hemorrhage or not.The baseline data of the pregnant women in the two groups were collected,univariate and multivariate regression analysis were used to find the risk factors of postpartum hemorrhage in the patients with scar uterus.At the same time,the diagnostic value of D-dimer in postpartum hemorrhage was analyzed.Results Univariate and multivariate Logistic regression analysis showed that delivery age,pregnancy times,times of history of curettage,gestational weeks,height of uterine fundus,neonatal weight,pregnancy complications and complications,uterine incision laceration were all risk factors for postpartum hemorrhage(P<0.05).The area under the curve of prenatal serum D-dimer level in predicting postpartum hemorrhage was 0.850(95%CI:0.796-0.904).Conclusions The risk factors of postpartum hemorrhage in patients with cicatricial uterus include delivery age,pregnancy times,times of history of curettage,gestational weeks,height of uterine fundus,weight of newborn,complications and complications of pregnancy,laceration of uterine incision,etc.By measuring prenatal D-dimer level,the occurrence of postpartum hemorrhage can be effectively predicted,which can provide reference for the early diagnosis and treatment of postpartum hemorrhage and improve the prognosis of postpartum hemorrhage patients.