阴道分娩产后出血发病率及影响因素的队列研究

目的探讨上海市孕产妇阴道分娩产后出血相关的影响因素。方法将2015年6月—2016年5月期间在上海市4家医院首次建卡产检的孕妇纳入队列,随访至分娩,收集其建卡、初次产检和分娩的资料。计算阴道分娩产后出血的发生率,并用独立样本t检验或方差分析进行单因素分析,用多元线性回归分析探讨阴道分娩产后出血量的影响因素。结果共收集到阴道分娩孕产妇资料3 495份,产后出血(500 mL)发生率为1.5%(53/3 495),产后出血量平均为(255.6±156.4)mL。多元线性回归分析显示,产次每增加1次,产后出血量下降13.3 mL;合并妊娠期高血压疾病和分娩巨大儿分别可使产后出血量升高42.3 mL和22.3 mL。结论上海市孕产妇阴道分娩产后出血发生率较低,提倡孕期的合理增重有利于控制产后出血量,对于初产妇和合并妊娠期高血压疾病的孕妇应积极防范产后出血的发生。

Incidence and risk factors of postpartum hemorrhage among vaginal delivery: a perspective cohort study

Objective To investigate the incidence of postpartum hemorrhage (PPH) among women with vaginal delivery in Shanghai,as well as the influencing factors.Methods Pregnant women (12-16 weeks of gestation) who had their first prenatal health examinations at 4 hospitals in Shanghai from June 2015 to May 2016 were recruited and followed up until delivery in this study.Data of their background information,clinical and lab extmination results and delivery outcomes were collected.The incidence of vaginal delivery PPH was calculated.T-test,analysis of variance and multivariate linear regression model were applied to identify the determinants.Results A total of 3 495 vaginal delivery women were included in the study.The incidence of PPH (＞500 mL) was 1.5％ (53/3 495),and the average amount of bleeding was (255.6 ± 156.4) mL.Multivariate linear regression analysis showed that compared with primipara,the blood loss of women delivered second baby was 13.3 mL lower.The amount of PPH in vaginal delivery could be increased by 42.3 mL due to hypertensive disorder complicating pregnancy (HDP) and 22.3 mL due to macrosomia.Conclusion The incidence of PPH among vaginal delivery in Shanghai is relatively low.Progestational weight control should be advocated,and maternity hospitals should pay high attention to the primipara or maternal with hypertensive disorder.