剖宫产未诊断的产后出血现状及影响因素研究

Status and influencing factors of undiagnosed abnormal postpartum blood loss during caesarean section

目的分析剖宫产未诊断的产后出血(UPPBL)现状及其相关影响因素。方法回顾性分析2019年1月—2020年6月于杭州师范大学附属医院住院并行剖宫产的415例产妇的临床资料,根据产后出血(PPH)和UPPBL的定义将其分为PPH组13例、UPPBL组41例和未发生产后出血组(对照组)361例。比较3组一般临床资料和剖宫产前1周内、剖宫产后第2天的Hb水平,分析影响剖宫产UPPBL的相关因素。结果415例产妇UPPBL的发生率为9.88%(41例);UPPBL组和PPH组在年龄、孕次、产次、早产比例、妊娠高血压发生率、胎盘粘连发生率等方面均明显高于对照组(均P<0.05);UPPBL组年龄明显高于PPH组,而孕次明显低于PPH组(均P<0.05)。3组剖宫产前1周内Hb水平差异无统计学意义(P>0.05),UPPBL组和PPH组剖宫产后第2天Hb水平均明显低于对照组(均P<0.05),2组剖宫产前与剖宫产后Hb水平变化明显高于对照组(P<0.05);年龄、孕次、产次、妊娠高血压、胎盘粘连、早产是影响UPPBL的因素。结论UPPBL在剖宫产产妇的发病率较高,年龄、孕次、产次、妊娠高血压、胎盘粘连、早产是影响剖宫产产妇发生UPPBL的因素,临床应采取相关措施以降低UPPBL的发生风险。

Objective To analyse the status of undiagnosed abnormal postpartum blood loss(UPPBL)during caesarean section and related influencing factors.Methods The clinical data of 415 women with caesarean section who were hospitalised in Affiliated Hospital of Hangzhou Normal University from January 2019 to June 2020 were retrospectively analysed.Based on the definition of postpartum haemorrhage(PPH)and UPPBL,they were divided into PPH(n=13),UPPBL(n=41)groups and the control group(n=361)without postpartum haemorrhage.The general clinical data of the three groups were compared with the level of haemoglobin(Hb)in the first week before caesarean section and the second day after caesarean section,and the related factors affecting UPPBL in caesarean section were analysed.Results The incidence of UPPBL in 415 parturients was 9.88%(41 cases).Compared with the control group,the UPPBL and PPH groups showed significantly higher values in terms of age,gestational order,delivery order,proportion of premature delivery,incidence of hypertension during pregnancy,incidence of placental adhesion and other aspects(all P<0.05).The age of UPPBL group was significantly higher than that of the PPH group,but the number of pregnancies was significantly lower(all P<0.05).No significant difference was observed in the Hb level between the three groups 1 week before the caesarean section(P>0.05).The Hb level in UPPBL and PPH groups on the second day after caesarean section was significantly lower than that in the control group(all P<0.05),and the Hb level before and after caesarean section in the two groups was significantly higher than that in the control group(P<0.05).Age,gestational order,delivery order,gestational hypertension,placental adhesion and premature delivery were influence factors that affected UPPBL.Conclusion The incidence of UPPBL is high in women who deliver by caesarean section.Age,gestational order,delivery order,gestational hypertension,placental adhesion and premature delivery are influence factors affecting the occurrence of UPPBL in women who deliver by caesarean section.Relevant measures should be implemented clinically to reduce the risk of UPPBL.