陰道分娩後胎盤滯留的高危因素分析

Risk factors of retained placenta after vaginal delivery

目的比較胎盤滯留(RP)組與對照組產婦臨床資料,探討RP發生的相關高危因素。方法單胎陰道分娩和無明顯胎兒異常的產婦共1865例,入組本研究。入組患者按照是否有RP,分為RP組和對照組。採取組間比較多項產科資料和多因素Logistic回歸分析,尋找RP發生的相關高危因素。結果RP組孕次、產次、人流次數≧2次、既往宮腔操作史、既往RP史、產後出血量和產後出血率,均顯著高於對照組。多因素回歸分析也顯示,產次、既往宮腔操作史、既往RP史、縮宮素使用時間>600分鐘是RP的獨立危險因素。結論孕婦孕前應盡量減少宮腔操作;醫護人員應盡量縮短縮宮素使用時間;同時注意識別上述高危因素的存在,在第三產程及時預警RP的發生。

Objective To identify retained placenta(RP)risk factors by comparing and screening medical history and laboring data of patients with and without RP.Methods A total of 1865 pregnant patients with vaginal delivery,singleton pregnancy and no major fetal anomaly were recruited and divided into the RP group and the control group.Medical history and laboratory data were compared between the two groups,and multivariable logistic regression analyses were applied to estimate the adjusted odds ratios(ORs)and 95%confidence intervals(CIs)for potential RP risk factors.Results The number of pregnancy times,the number of delivery times,the percentage of≥2 manual abortions,the percentage of patients with intrauterine procedures and with RP history,the amount of postpartum hemorrhage blood and the percentage of patients with postpartum hemorrhage were significantly higher in the RP group than in the control group.Multivariable logistic regression analyses showed that multiple deliveries,previous intrauterine procedures,RP history and≥600 min oxytocin application were independent risk factors for RP.Conclusion Intrauterine procedures should be reduced as few times as possible before pregnancy.During labor,oxytocin application time should be minimized.In the meantime,during the third stage of labor,the RP alert should be set up immediately as the abovementioned RP risk factors are noticed.