北京市6194例阴道分娩产后出血影响因素分析

Analysis of influencing factors of postpartum hemorrhage in 6194 cases of vaginal delivery in Beijing

目的分析阴道分娩产后出血的影响因素,对预防阴道分娩产后出血提供科学依据。方法选取北京市妇幼保健管理信息系统中分娩时间在2022年1月1日至2022年12月31日、孕周≥28周阴道分娩产后出血的产妇6194例为出血组,同期孕周≥28周、阴道分娩无产后出血的产妇71360例为无出血组,对产后出血进行统计分析。结果北京市阴道分娩产后出血发生率为7.99%。单因素分析结果显示出血组与无出血组在年龄、身体质量指数(BMI)、产后出血史、孕次、产次、多胎、妊娠高血压疾病、子宫肌瘤、胎盘因素、分娩前贫血、分娩孕周、巨大儿、死胎、会阴侧切、阴道助产、总产程延长方面差异均有统计学意义(χ^(2)值分别为9.730、117.691、9.093、4.419、189.054、211.420、176.115、7.975、50.866、12.784、127.993、216.439、5.841、140.000、180.000、10.886,P<0.05)。多因素分析结果显示,年龄≥35岁、BMI 25.0~27.9kg/m^(2)、BMI≥28.0kg/m^(2)、产后出血史、孕次≥3次、多胎、妊娠期高血压疾病、胎盘因素、分娩前贫血、分娩孕周≥41周、巨大儿、死胎、会阴侧切、阴道助产是阴道分娩产后出血的危险因素,OR及其95%CI值分别为1.210(1.124~1.302)、1.328(1.212~1.455)、1.284(1.134~1.454)、2.304(1.549~3.427)、1.171(1.079~1.272)、4.172(3.322~5.238)、1.772(1.602~1.959)、3.870(2.599~5.763)、1.197(1.096~1.307)、1.462(1.340~1.595)、2.019(1.811~2.251)、1.667(1.078~2.578)、2.017(1.896~2.145)、2.854(2.642~3.083),P<0.05;BMI<18.5kg/m^(2)、经产妇、早产是阴道分娩产后出血的保护因素,OR及其95%CI值分别为0.747(0.670~0.833)、0.795(0.735~0.859)、0.847(0.735~0.976),P<0.05。结论北京市阴道分娩产后出血发生率较高,加强婚前及孕前保健的健康教育、提升产科与营养科的进一步合作、加强妊娠期间贫血管理、进一步提高助产技能水平等是减少产后出血发生率的重要措施。同时,结合该研究产后出血影响因素的分析,借助北京市妇幼保健管理信息系统,利用信息化手段,实现现代化产后出血预警机制也是下一步要考虑的方向。

Objective To analyze the influencing factors of postpartum hemorrhage in vaginal delivery,and provide a scientific basis for the prevention of postpartum hemorrhage in women with natural delivery.Methods A total of 6194 women with vaginal delivery and postpartum hemorrhage at a gestational age of≥28 weeks from January 1,2022 to December 31,2022 were selected as the hemorrhage group,and 71360 women with a gestational age of≥28 weeks and vaginal delivery without postpartum hemorrhage during the same period were selected as the non-hemorrhage group,and statistical analysis was conducted on postpartum hemorrhage.Results The incidence of postpartum hemorrhage in vaginal delivery in Beijing was 7.99%.The results of univariate analysis showed that there were statistically significant differences between the hemorrhage group and the non-hemorrhage group in age,body mass index(BMI),history of postpartum hemorrhage,pregnancy,parity,multiple births,hypertensive disorders during pregnancy,uterine fibroids,placental factors,prenatal anemia,gestational week at delivery,macrosomia,stillbirth,perineal incision,vaginal delivery,and total labor duration.(χ^(2)=9.730,117.691,9.093,4.419,189.054,211.420,176.115,7.975,50.866,12.784,127.993,216.439,5.841,140.000,180.000 and 10.886,respectively,P<0.05).The results of multivariate analysis showed that age≥35 years old,BMI 25.0-27.9kg/m^(2),BMI≥28.0kg/m^(2),history of postpartum hemorrhage,pregnancy≥3 times,multiple births,hypertensive disorders during pregnancy,placental factors,prenatal anemia,gestational age at delivery≥41 weeks,macrosomia,stillbirth,perineal incision,and vaginal delivery were risk factors for postpartum hemorrhage in vaginal delivery.OR and 95%CI were 1.210(1.124-1.302),1.328(1.212-1.455),1.284(1.134-1.454),2.304(1.549-3.427),1.171(1.079-1.272),4.172(3.322-5.238),1.772(1.602-1.959),3.870(2.599-5.763),1.197(1.096-1.307),1.462(1.340-1.595),2.019(1.811-2.251),1.667(1.078-2.578),2.017(1.896-2.145)and 2.854(2.642-3.083),respectively,P<0.05.BMI<18.5kg/m^(2),multipara,premature delivery were protective factors of postpartum hemorrhage in vaginal delivery,OR and 95%CI were 0.747(0.670-0.833),0.795(0.735-0.859)and 0.847(0.735-0.976),respectively,P<0.05.Conclusion The incidence of postpartum hemorrhage in vaginal delivery in Beijing is relatively high.Strengthening health education of pre-marital and pre-pregnancy health care,improving further cooperation between obstetrics and nutrition,strengthening anemia management during pregnancy,and further improving midwifery skills are important measures to reduce the incidence of postpartum hemorrhage.At the same time,combined with the correlation of influencing factors of postpartum hemorrhage in this study,with the help of Beijing maternal and child health management information system,using information means,realizing the modern early warning mechanism of postpartum hemorrhage is also the next step to consider.