197例前置胎盘重度严重产后出血及子宫切除危险因素分析

Analysis of severe delivery and uterine risk factors of severe postpartum hemorrhage of placenta previa and hysterectomy in 197

目的:探究前置胎盘发生重度严重产后出血的相关危险因素及导致子宫切除不良事件发生的危险因素。方法:选取2017年1月至2022年3月于我院住院手术分娩且发生严重产后出血(Postpartum hemorrhage,PPH)的197例前置胎盘患者作为研究对象进行回顾性分析。所有患者根据出血量分为研究组(出血量≥2000 mL)和对照组(1000 mL<出血量≤2000 mL),并将符合重度严重PPH分为子宫切除组和非子宫切除组。通过单因素、多因素Logistic回归分析,分析导致重度严重PPH的相关危险因素以及重度严重PPH患者子宫切除的相关因素。结果:单因素分析显示重度严重产后出血与产次、瘢痕子宫、胎盘位置、胎盘植入情况、凶险性前置胎盘和使用腹主动脉球囊与呈正相关,与孕周和分娩前血红蛋白呈负相关(P<0.05),多因素Logistic回归分析表明小孕周(28 w≤孕周<34 w)、胎盘植入是重度严重产后出血的独立因素(P<0.05)。对于重度严重产后出血患者,子宫切除与出血量、凶险性前置胎盘和胎盘植入相关(P<0.05)。结论:前置胎盘合并小孕周、胎盘植入是导致重度严重产后出血的独立因素,而出血量的多少、凶险性前置胎盘、胎盘植入是导致前置胎盘切除子宫的危险因素。

Objective:To explore the risk factors of severe postpartum hemorrhage in placenta previa and the risk factors leading to adverse events of hysterectomy.Methods:The clinical data of 197 patients with placenta previa complicated with severe postpartum hemorrhage were collected and divided into study group(n=80,bleeding volume≥2000 mL)and control group(n=117,1000 mL<bleeding volume≤2000 mL).Univariate analysis and multivariate logistic regression were used to analyze the risk factors of severe postpartum hemorrhage and the related factors of hysterectomy in patients with severe postpartum hemorrhage.Results:Univariate analysis showed that severe postpartum hemorrhage was positively correlated with parity,cicatricial uterus,placenta location,placenta accreta,pernicious placenta previa and use of abdominal aortic balloon,but negatively correlated with gestational age and prepartum hemoglobin(P<0.05).Multivariate logistic regression analysis showed that small gestational weeks(28weeks≤gestational weeks<34weeks)and placenta accreta were independent factors of severe postpartum hemorrhage.For patients with severe postpartum hemorrhage,hysterectomy was associated with blood loss,pernicious placenta previa and placenta accreta(P<0.05).Conclusion:Placenta previa with small gestational weeks and placenta accreta are the independent factors leading to severe postpartum hemorrhage,while the amount of bleeding,pernicious placenta previa and placenta accreta are the risk factors leading to placenta previa hysterectomy.