瘢痕子宫再妊娠经剖宫产分娩产后出血的影响因素分析

目的 探讨瘢痕子宫再妊娠经剖宫产分娩产后出血(PPH)的影响因素。方法 回顾性分析2021年8月至2022年12月263例瘢痕子宫再次剖宫产分娩产妇临床资料,以是否发生PPH,分为PPH组(n=25)和非PPH组(n=238),采用单因素与多因素Logistic回归模型分析产妇二次剖宫产并发PPH的影响因素。结果 263例产妇PPH发生率为9.51%,PPH组流产次数、硫酸镁保胎史、产前出血、合并凶险性前置胎盘、切口撕裂、宫缩乏力等高于非PPH组(P<0.05),产前血红蛋白、产前纤维蛋白原水平低于非PPH组(P<0.05)。Logistic回归分析,既往人流次数≥3次(OR=3.122)、产前纤维蛋白原≤3 g/L(OR=2.510)、妊娠合并凶险性前置胎盘(OR=7.903)、宫缩乏力(OR=4.096)、子宫切口撕裂(OR=5.831)是产妇二次剖宫产并发PPH的危险因素。结论 避免意外妊娠减少流产次数,加强产前纤维蛋白原指标监测,重视凶险性前置胎盘及宫缩乏力的处理,警惕术中切口撕裂,能有效预防PPH的发生。

Objective To explore the risk factors of postpartum hemorrhage in cesarean section delivery women with scar uterus re pregnancy.Methods A retrospective selection was conducted on Medical records 263 puerperant who underwent scar uterus was followed by another cesarean section obstetrics department of Hangzhou Obstetrics and Gynecology Between August 2021 and December 2022.Whether to is postpartum bleeding,hemorrhage group(n=25)and non postpartum hemorrhage group(n=238)based on whether there was postpartum hemorrhage.Single factor and multiple factor Logistic regression models were used to screen for independent risk factors for postpartum hemorrhage in pregnant women who underwent cesarean section for scar uterine re pregnancy.Results The incidence of maternal PPH in 263 cases was 9.51%(25/263),showed that the postpartum hemorrhage group had significantly higher miscarriage frequency,history of magnesium sulfate for fetal protection,prenatal bleeding,combination of dangerous placenta previa,placental implantation or adhesion,and uterine contractions compared to the non postpartum hemorrhage group(P<0.05).The levels of prenatal hemoglobin and fibrinogen were lower than those of the non postpartum hemorrhage group(P<0.05).Logistic regression analysis:The number of abortion≥3(OR=3.122),prenatal fibrinogen≤3 g/L(OR=2.510),dangerous placenta previa(OR=7.903),uterine atony(OR=4.096),and uterine incision tear(OR=5.831)Is a risk factor for maternal secondary cesarean section with PPH.Conclusion Avoid unintended pregnancy to reduce the number of abortion,strengthen prenatal fibrinogen index monitoring,pay attention to the treatment of dangerous placenta previa and uterine contraction weakness,alert to the occurrence of intraoperative uterine incision tear,help to prevent and reduce the occurrence of severe postpartum bleeding.