6124例产后出血相关因素分析

目的:测定产后24h内的出血情况,研究产后出血的相关因素及与生命体征变化的相关性,探讨产后出血的诊断标准,以制订预防措施。方法:产时应用容积法+面积法,产后用称重法进行测量。结果:6124例产妇总的平均出血量为410ml,其中阴道顺产2881例,阴道助产133例,剖宫产3110例。平均出血量分别是385.3ml、445.3ml、431.3ml。2h内出血量占总出血量的69.40%。若以出血量≥500ml为产后出血的诊断标准,则总的产后出血率是15.69%,顺产、助产、剖宫产的产后出血率分别为14.68%、25.56%、16.21%。若以出血量≥600ml为诊断标准,则总的出血率是7.77%,顺产、助产、剖宫产的出血率分别是7.12%、17.29%、7.97%。出血量≥700ml开始血压下降,出血量≥900ml输血率明显升高。有产后出血高危因素者及多产妇的出血量明显增多。结论:手术产较顺产出血量要多,尤以阴道助产为甚。降低剖宫产率,提高助产技术是减少产后出血的主要手段。对有产后出血高危因素者应做好预防措施。产后出血诊断标准以≥600ml为宜。

Analysis on factors related to postpartum hemorrhage: report with 6 124 cases

Objective:To calculate volume of hemorrhage in 24 h,and investigate the factors related to postpartum hemorrhage and their relationship with life signs, as well as discuss its diagnostic criteria and formulate prevention measures.Methods:The volume of hemorrhage was determined by volumetric and area method during labor and weighing-in method after labor.Results:The amount of average postpartum hemorrhage in 6 124 cases was 410 ml, including three groups of 2 881 normal vaginal labor cases, 133 vaginal assistant labor ones, 3 110 cesarean ones with the average hemorrhage volume 385.3, 445.3, 431.3 ml, respectively. The amount of postpartum hemorrhage in 2 h accounted for 69.4% of total bleeding volume. If more than ≥500 ml of bleeding amount were regarded as diagnostic criteria of postpartum hemorrhage, the total rate of hemorrhage would be 15.69%,the postpartum hemorrhage rate was 14.68% in normal vaginal labor, 25.56% in vaginal assistant labor, 16.21% in cesarean section, respectively. If more than ≥600 ml of bleeding amount as diagnostic criteria, the total hemorrhage rate would be 7.77%, the bleeding rate of the above groups was 7.12% , 17.29%, 7.97%, respectively. The patients' blood pressure began to come down as amount ≥700 ml, and the rate of blood transfusion increased obviously as amount ≥900 ml. The hemorrhage volume of pregnant women with high-risk factors and multiparas significantly increased.Conclusion:The amount of bleeding in operative labors was more than that in normal labor, especially vaginal assistant labor. The important methods to reduce postpartum hemorrhage were decreasing cesarean rate and promoting technology of assistant labor. Prevention measures should be adopted for patients with high-risk factors of postpartum hemorrhage. The diagnostic criteria of postpartum hemorrhage should be ≥600 ml.