严重产后出血的临床分析

Clinical analysis of 72 Patients with severe PPH

目的 分析严重产后出血的直接原因和高危因素的构成比,从而能有针对性的干预,进一步降低产后出血的发生和孕产死亡率。方法 回顾性分析2012年1月至2021年12月在上海交通大学医学院附属瑞金医院分娩的72例产后出血大于1 000mL的产妇,根据入院时间把将产妇分为2组:2012年1月至2016年12月入院者作为A组,2017年1月至2021年12月入院者作为B组,分析产后出血的直接原因和高危因素构成比的变化,以及切除子宫和未切除子宫患者的临床特点差异。结果 B组接受试管婴儿助孕的比例明显高于A组,差异有统计学意义(45.71%vs.24.32%,χ^(2)=5.763,P<0.05);B组胎盘因素(42.86%vs.32.43%)、子痫前期(20.00%vs.10.81%)的构成比高于A组,但差异无统计学意义(P>0.05)。本次剖宫产比例在A组、B组均较高,分别是91.89%、82.86%。在接受子宫切除术的患者中,以往有剖宫产史的产妇比例明显高于未接受子宫切除的产妇(70.0%vs.16.13%,χ^(2)=13.855,P<0.05),胎盘粘连、前置及植入的比例也明显高于未切除子宫的产妇(60.0%vs.33.87%,χ^(2)=5.234,P<0.05)。结论 随着辅助生殖技术的广泛应用,导致严重产后出血的常见原因是辅助生殖受孕和产科并发症。在接受子宫切除术的患者中,剖宫产史和胎盘前置、植入成为产后出血的最常见原因。

Objective To analyze the direct causes of severe postpartum hemorrhage and the composition ratio of high-risk factors in order to be able to target interventions to further reduce the incidence of postpartum hemorrhage and maternal mortality.Methods A retrospective analysis of 72 women with postpartum hemorrhage(PPH)more than 1000mL who delivered at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2012 to December 2021 was performed,and the women were divided into 2 groups according to the time of admission:January 2012 to December 2016(group A)and January 2017 to December 2021(group B).Changes in the composition ratio of direct causes and high-risk factors for postpartum hemorrhage were analyzed,as well as differences in the clinical characteristics of patients with and without hysterectomy.Results The proportion of group B receiving in vitro fertilization(IVF)assisted pregnancy was significantly higher than group A,with a statistically significant difference(45.71%us.24.32%,χ^(2)=5.763,P<0.05).The composition ratios of placental factors(42.86%us.32.43%)and pre-eclampsia(20.0%vs.10.81%)were higher in group B than in group A,but the difference was not statistically significant(P>0.05).The proportion of this cesarean section was higher in both groups A and B,91.89%and 82.86%respectively.Among those who underwent a hysterectomy,the proportion of women with a history of previous cesarean section was significantly higher than those who did not undergo a hysterectomy(70.0%vs.16.13%,χ^(2)=13.855,P<0.05),and the proportion of women with placental adhesions,previa,and implantation was also significantly higher than those who did not undergo hysterectomy(60.0%vs.33.87%,χ^(2)=5.234,P<0.05).Conclusion As the use of assisted reproductive technology becomes more widespread,the common causes of severe PPH are assisted reproductive conception and obstetric complications.In patients undergoing hysterectomy,a history of cesarean section and placenta previa and implantation become the most common causes of postpartum hemorrhage.