经阴道分娩260例产妇阴道壁血肿形成的主要危险因素分析

Analysis of Major Risk Factors for Hematoma Formation of Vaginal Wall in 260 Maternal Vaginal Deliveries

目的通过回顾性病例对照研究,对经阴道分娩产妇阴道壁血肿形成的主要危险因素进行分析,为预防其发生及制定护理干预提供支持。方法将2013年1月—2022年9月在厦门市妇幼保健院经阴道分娩发生阴道壁血肿的260例产妇纳入观察组,按照1∶1比例选取同期未发生阴道壁血肿260例作为对照组。对比2组产妇各项资料之间的差异,分析导致阴道壁血肿发生的相关危险因素,通过logistic回归分析产妇阴道壁血肿形成的主要危险因素。结果2013年1月—2022年9月阴道分娩81545例,发生阴道壁血肿260例,经阴道分娩产妇阴道壁血肿的平均发生率为0.318%(260/81545);2组产妇年龄、身高、体质量、第一产程时间、第二产程时间、贫血、乙肝病毒表面抗原携带、妊娠期肝损伤、身体质量指数(body mass index,BMI)比较,差异无统计学意义(P>0.05);2组产次、急产、巨大儿、阴道助产、产道切开、妊娠期高血压比较,差异有统计学意义(P<0.05);通过多因素logistic回归分析结果显示,急产、巨大儿、阴道助产以及妊娠期高血压是阴道壁血肿形成的主要危险因素(P<0.05)。结论急产、巨大儿、阴道助产以及妊娠期高血压的产妇经阴道分娩过程中出现阴道壁血肿的风险较高,在分娩前对产妇进行评估并护理,可降低阴道壁血肿的发生率,改善预后。

Objective To analyze the main risk factors for the formation of vaginal wall hematoma in parturient women during vaginal delivery and explore the nursing countermeasures.Methods From January 2013 to September 2022,a total of 260 women who had vaginal hematomas in Xiamen Maternal and Child Health Care Hospital during vaginal delivery were included in the observation group,and 260 cases without vaginal hematomas were collected as the control group according to the ratio of 1:1.The differences in various data between the two groups were compared.The related risk factors of birth canal hematoma were analyzed.The main risk factors of birth canal hematoma were analyzed by logistic regression.Results From January 2013 to September 2022,a total of 81545 cases of vaginal delivery were recorded,among which there were 260 cases of vaginal wall hematoma.The average incidence rate of vaginal wall hematoma in women who underwent vaginal delivery was 0.318%(260/81545).There were no significant statistical differences in age,height,weight,first stage of labor,second stage of labor,anemia,hepatitis B surface antigen carriage,pregnancy-related liver injury,and body mass index(BMI)between the two groups(P>0.05).However,there were statistically significant differences in parity,emergency delivery,macrosomia,vaginal assisted delivery,perineal laceration,and pregnancy-induced hypertension between the two groups(P<0.05).Multifactorial logistic regression analysis indicated that emergency delivery,macrosomia,vaginal assisted delivery,and pregnancy-induced hypertension were the main risk factors for the formation of vaginal wall hematomas(P<0.05).Conclusion Women with emergency delivery,macrosomia,vaginal assisted delivery,and pregnancy-induced hypertension have a higher risk of vaginal wall hematoma during vaginal delivery.Evaluation and nursing before delivery can reduce the incidence of vaginal hematomas and improve the prognosis.