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产后出血危险因素的分析和预防措施的研究

王玥   

  1. 天津市中心妇产科医院
  • 收稿日期:2012-11-27 修回日期:2013-04-28 出版日期:2013-09-15 发布日期:2013-09-15
  • 通讯作者: 王玥

The Analysis of the Risk Factors and Prevention Measures for Postpartum Hemorrhage

  • Received:2012-11-27 Revised:2013-04-28 Published:2013-09-15 Online:2013-09-15

摘要:

【摘要】 目的  探讨产后出血的相关危险因素及降低其发生率的有效方法。 方法  回顾性分析在我院分娩的3786例产妇的临床资料,采用Logistic回归分析,筛选与产后出血有关的危险因素。结果  采用称量法+容积法测量产后出血量,3786例产妇中有135例(3.57%)符合产后出血的诊断标准。单因素分析显示年龄、分娩史、分娩方式、前置胎盘、胎盘早剥、胎盘粘连或植入和(或)胎盘滞留、宫缩乏力、软产道损伤、贫血状况、妊娠高血压病史不同产妇的产后出血发生情况比较差异有统计学意义。多因素Logistic回归分析显示宫缩乏力,前置胎盘,胎盘粘连、植入、滞留及剖宫产为产后出血的危险因素。 结论   积极防治宫缩乏力,加强孕期保健知识的普及,严格掌握剖宫产指征能够有效降低产后出血的发生率。

关键词: 产后出血, 危险因素, Logistic模型, 剖宫产术, 前置胎盘

Abstract: 【Abstract】 Objective To analyze the risk factors and prevention measures for postpartum hemorrhage. Methods 3786 cases who gave birth in our hospital from May 2011 to December 2011 were analyzed retrospectively. The Logistic regression was used to analysis the risk factors of the postpartum hemorrhage. Results Based on the amount of blood loss, measuring by the weight and volume estimation, there were 135 cases out of 3786 defined as postpartum hemorrhage and the incidence was 3.57%. Due to the single factor analysis, there were 11 factors associated with postpartum hemorrhage, including age, delivery history, the manner of delivery, placenta previa, placental abruption, adherence implantation or residual of placenta, uterine atony, injury of birth canal, anemia, coagulation disorders, pregnancy-induced hypertension history. According to the multiple factor analysis, 4 factors entered the logistic regression model, including uterine atony (OR=15.132,95%CI 13.342~16.701), placenta previa (OR=10.897,95%CI 9.256~11.347 ), adherence implantation or residual of placenta (OR=30.310,95%CI 23.312~35.514)and cesarean section (OR=4.018,95%CI 3.331~4.522 ). Conclusion Uterine atony, placenta previa, adherence implantation or residual of placenta and cesarean section were the risk factors of the postpartum hemorrhage. Pay attention to prevent the uterine atony. Strengthen the knowledge of perinatal care as much as possible and reduce the rate of cesarean section can help reducing the incidence of postpartum hemorrhage and obstetric mortality.