前置胎盘产妇产后出血相关因素分析

Analysis of related factors of postpartum hemorrhage in women with placenta previa

目的:探讨影响前置胎盘产妇发生产后出血的相关因素。方法:回顾分析2010年1月1日至2019年12月31日南京医科大学第一附属医院产科重症病区(OICU)收治的395例前置胎盘孕妇的病例资料,行单因素和二元logistic回归模型分析产妇发生产后出血的相关因素。结果:产后出血组和无产后出血组的孕次、流产次数≥3次比例、瘢痕子宫比例和产前血红蛋白比较,差异均有统计学意义(P<0.05)。产后出血组中前置胎盘合并瘢痕子宫及胎盘植入的比例、介入使用率和子宫切除率、术中出血量均显著高于无产后出血组。logistic回归分析结果显示,前置胎盘合并瘢痕子宫、既往剖宫产次数、胎盘植入和术中出血量是产后出血的危险因素(P<0.05);产前血红蛋白是产后出血的保护性因素。近10年前置胎盘发生率呈上升趋势,前置胎盘产妇发生产后出血比率以2015年为峰值,呈“先升后降”的趋势,前置胎盘孕妇入住OICU的天数呈缓慢下降趋势,目前集中于6~7d出OICU,新生儿NICU转诊率呈大幅度下降趋势。结论:前置胎盘合并瘢痕子宫、既往剖宫产次数≥2次、术中出血量和胎盘植入是影响前置胎盘产后出血的主要危险因素,产前血红蛋白是影响前置胎盘出血的保护性因素。可根据主次因素分析并预测前置胎盘产后出血几率,加强其围手术期预防产后出血的诊治,降低因产后出血导致前置胎盘产妇转归不良风险。随着医学进步及孕妇规律产检意识的增强,前置胎盘孕产妇母儿不良转归发生率整体呈下降趋势。

Objective:To explore the related factors of postpartum hemorrhage in women with placenta previa.Methods:The case datas of 395 pregnant women with placenta previa admitted to the Obstetrical Intensive Care Unit(OICU)of the First Affiliated Hospital of Nanjing Medical University from January 1,2010 to December 31,2019 were reviewed and analyzed.The related factors of postpartum hemorrhage were analyzed by univariate and binary logistic regression models.Results:There were statistically significant differences between the postpartum hemorrhage group and the group without postpartum hemorrhage in the proportion of pregnancy times,abortion times≥3 times,the proportion of scar uterus and prenatal hemoglobin(P<0.05).In the postpartum hemorrhage group,the proportion of placenta previa with scar uterus and placenta accreta,the rate of interventional use,the rate of hysterectomy and the amount of intraoperative bleeding were significantly higher than those in the non-partum hemorrhage group.The results of logistic regression analysis showed that placenta previa with scar uterus,previous cesarean section times,placenta implantation and intraoperative bleeding were risk factors for postpartum hemorrhage(P<0.05).Prenatal hemoglobin is a protective factor for postpartum hemorrhage.The incidence of placenta previa has been on the rise in the past 10 years.The rate of postpartum hemorrhage in women with placenta previa peaked in 2015,showing a trend of"rising first and then falling".The number of days of women with placenta previa staying in the OICU has been declining slowly.At present,it is concentrated on leaving the OICU on the 6th to 7th day,and the referral rate of neonatal NICU has declined significantly.Conclusion:The main risk factors of postpartum hemorrhage of placenta previa are placenta previa complicated with scar uterus,the number of previous cesarean section≥2 times,the amount of intraoperative bleeding and placenta accreta,and prenatal hemoglobin is the protective factor of postpartum hemorrhage of placenta previa.We can analyze and predict the probability of postpartum hemorrhage of placenta previa according to the primary and secondary factors,strengthen the diagnosis and treatment of preventing postpartum hemorrhage during the perioperative period,and reduce the risk of adverse outcome of placenta previa due to postpartum hemorrhage.With the progress of medical science and the enhancement of the awareness of regular antenatal examination of pregnant women,the incidence of maternal and fetal adverse outcome of placenta previa in pregnant women has declined as a whole.