再次剖宫产术中出血的临床分析

Clinical analysis of intraoperative hemorrhage in repeat cesarean section

目的 探讨再次剖宫产术中出血的发生原因和预防措施。方法 对 1997～ 2 0 0 2年 2 84 1例再次剖宫产(RS组 )和 5 6 82例首次剖宫产 (CS组 )病例导致术中出血原因进行分析。结果 RS组的平均出血量、术中出血发生率 ,显著高于CS组 (P <0 0 5 ) ;导致再次剖宫产术中出血的原因依次为胎盘因素、子宫切口的撕裂、宫缩乏力、子宫破裂 ;两次剖宫产相距时间 <2年、首次剖宫产有腹腔粘连和古典式剖宫产者 ,术中出血发生率显著升高。结论 首次剖宫产子宫切口愈合情况、切口位置的选择和胎盘附着的部位 ,对再次剖宫产术中出血起决定性作用。

Objective To explore the causes and the prevention of intraoperative hemorrhage in repeated cesarean section.Methods The causes of intraoperative hemorrhage were studied retrospectively in 2841 cases of repeat cesarean section (RS group) and 5682 cases of primary cesarean section (CS group) performed during 1997～2002.Results The average blood loss and rate of intraoperative hemorrhage in RS group were significantly increased compared with that of CS group.The causes of intraoperative hemorrhage in RS group were placenta factors,uterine laceration,uterine atony,uterine rupture.The rate of intraoperative hemorrhage in the cases of less than 2 years’ period after primary cesarean section with intra-abdominal adhesions and classical uterine incision in the primary operation was significantly higher.Conclusion The healing of uterine incision, the type of previous uterine section and the locus of placenta play important roles in intraoperative hemorrhage of repeat casarean section.