二孩剖宫产产后出血危险因素及与宫内节育器相关性

Analysis of the relationship between intrauterine device used of women and their risk factors of postpartum hemorrhage after the second child birth by cesarean section

目的:探讨二孩剖宫产产后出血的影响因素及与宫内节育器(IUD)的相关性。方法:采用病例对照研究方法收集连云港地区孕产保健系统2017年1月-2018年12月剖宫产分娩且符合纳入标准的二胎产妇4994例,其中产后出血量≥1000 ml 120例为病例组,按1:2完全随机抽取产后出血量<1000 ml的240例产妇为对照组,logistic回归分析产后出血的影响因素。结果:年龄(OR=7.228,95%CI 3.420~15.274)、流产史(OR=2.121,95%CI 1.198~3.755)、多胎妊娠(OR=1.923,95%CI 1.067~3.465)、巨大儿(OR=6.558,95%CI 3.608~11.92)、前置胎盘(OR=4.300,95%CI 1.572~11.757)是产后出血的独立影响因素,使用IUD不是产后出血的独立影响因素(OR=7.608,95%CI 0.778~74.396)。结论:放置IUD对剖宫产产后出血没有影响,值得拟生育二胎妇女使用。控制产后出血的危险因素可以预防剖宫产产后出血的发生。

Objective:To analyze the relationship between intrauterine device(IUD)used of women and their risk factors of postpartum hemorrhage after the second child birth by cesarean section.Methods:A case-control study was conducted to analyze the postpartum hemorrhage situation of 4,994 parturients with the second child birth by cesarean section from January 2017 to December 2018 and who met the inclusion criteria in the maternal health care system of Lianyungang area.Among them,120 parturients with postpartum blood loss≥1,000 ml were classified in case group,and according to 1:2,240 parturients with postpartum hemorrhage<1,000 ml were randomly selected in control group.The influence factors of postpartum hemorrhage were analyzed by logistic regression analysis.Results:Age(OR=7.228,95%CI 3.420-15.274),history of abortion(OR=2.121,95%CI 1.198-3.755),multiple pregnancy(OR=1.923,95%CI 1.067-3.465),macrosomia(OR=6.558,95%CI 3.608-11.92),and placenta previa(OR=4.300,95%CI 1.572-11.757)were the independent influencing factors of postpartum hemorrhage,but IUD used was not the independent influencing factor of postpartum hemorrhage(OR=7.608,95%CI 0.778-74.396).Conclusion:IUD used has no adverse influence on the postpartum hemorrhage of the women after cesarean section,so IUD is worth to use as the contraception for the women safely who plan to give birth the second child.Controlling the risk factors of the women can prevent their occurrence of postpartum hemorrhage after cesarean section.