前置胎盘产妇剖宫产术产后出血的相关影响因素分析

Analysis of Related Influencing Factors of Postpartum Hemorrhage in Postpartum Women with Placenta Previa Undergoing Cesarean Section

目的:探讨前置胎盘产妇剖宫产术产后出血的相关影响因素。方法:回顾性分析2019年3月—2022年10月平顶山市妇幼保健院行剖宫产术分娩的106例前置胎盘产妇临床资料。所有产妇均依据剖宫产术后产后出血发生情况分为发生组与未发生组,通过查阅病历资料、电话随访等方式收集两组产妇年龄、孕次、生产情况、文化程度、宫腔操作次数、前置胎盘类型、合并胎盘植入、瘢痕子宫、本次剖宫产切口、子宫按摩、合并妊娠期高血压、合并妊娠期糖尿病、胎盘附着位置等多方面基础资料,先行单因素分析,得到差异有统计学意义的项目再行logistic回归分析,获得影响前置胎盘产妇剖宫产术产后出血的独立危险因素。结果:106例前置胎盘产妇剖宫产术后发生产后出血42例,发生率为39.62%(42/106);两组产妇年龄、宫腔操作次数、前置胎盘类型、合并胎盘植入、瘢痕子宫、子宫按摩、合并妊娠期高血压、胎盘附着位置相比,差异有统计学意义(χ^(2)=21.916、18.634、33.174、28.404、11.349、7.714、4.696、17.774,P<0.05);多因素分析结果显示,年龄≥35岁、宫腔操作次数≥2次、完全性前置胎盘、合并胎盘植入、瘢痕子宫、合并妊娠期高血压、胎盘附着前壁和未子宫按摩为影响前置胎盘产妇剖宫产术产后出血的高危因素(OR>1)。结论:前置胎盘产妇剖宫产术产后出血风险高,临床认为与年龄≥35岁、宫腔操作次数≥2次、完全性前置胎盘、合并胎盘植入、瘢痕子宫、合并妊娠期高血压、胎盘附着前壁、未子宫按摩关系密切,还需尽早识别高危群体,并做好出血防治措施,保障产妇安全。

Objective:To explore the relevant influencing factors of postpartum hemorrhage after cesarean section in women with placenta previa.Methods:A retrospective analysis was conducted on the clinical data of 106 postpartum women with placenta previa who underwent cesarean section in the hospital from March 2019 to October 2022.All the parturients were divided into the occurrence group and the non occurrence group according to the occurrence of postpartum hemorrhage after cesarean section.Age,pregnancy times,production conditions,educational level,uterine cavity operation times,placenta previa type,placenta accreta,scar uterus,this cesarean section incision,uterine massage,hypertension in pregnancy,diabetes in pregnancy,and placental attachment location were analyzed with univariate analysis to identify statistically significant items,followed by logistic regression analysis to identify independent risk factors for postpartum hemorrhage in women with placenta previa after cesarean section.Single factor analysis and logistic regression analysis were conducted.Results:42 out of 106 postpartum women with placenta previa experienced postpartum bleeding after cesarean section,with an incidence rate of 39.62%(42/106).There was statistically significant difference between the two groups in age,number of intrauterine procedures,type of placenta previa,concurrent placental implantation,scarred uterus,uterine massage,concurrent gestational hypertension,and placental attachment position,with statistically significant difference(χ^(2)=21.916,18.634,33.174,28.404,11.349,7.714,4.696,17.774;P<0.05).Multivariate analysis showed that age≥35 years,uterine cavity operations≥2 times,completeness placenta previa,placenta accreta,scar uterus,the combination of gestational hypertension,placental attachment to the anterior wall,and no uterine massage were high-risk factors for postpartum hemorrhage in women with placenta previa after cesarean section(OR>1).Conclusion:The risk of postpartum hemorrhage after cesarean section for women with placenta previa is high.It is closely related to the age≥35 years,the number of uterine cavity operations≥2,completeness placenta previa,placental implantation,scarred uterus,hypertension during pregnancy,placental attachment to the front wall,and uterine massage.It is also necessary to identify high-risk groups as soon as possible,and do well in bleeding prevention and control measures to ensure the safety of women.