1999年南京市剖宫产术产后出血情况分析

目的了解南京市妇女剖宫产术后24 h内的失血量及出血情况.方法对南京市城、郊、县的一、二、三级医院,按东、西、南、北、中的地理位置进行分层抽样调查,各调查单位按连续病案号的方法纳入观察对象.出血量测量方法为容积法+称重法+面积法.结果抽样的4 171例产妇中,1 125例为剖宫产分娩,其剖宫产指征依次为头盆不称、胎儿窘迫、臀位;剖宫产指征不明确者占10.4%.剖宫产术产后出血量中位数为520 ml,明显高于阴道分娩者(3 046例)的397 ml(P<0.01).若以出血量≥500 ml为产后出血的诊断标准,则剖宫产术产后出血发生率高达53.7%,无出血高危因素的剖宫产者,第80百分位数产后出血量为678 ml;若以出血量≥700 ml为诊断标准,则剖宫产术产后出血发生率为19.8%.结论 (1)剖宫产术本身就是产后出血的原因,为母亲健康,应努力降低剖宫产率;(2)剖宫产术产后出血的诊断标准以出血量≥700 ml为宜.

Study on postpartum hemorrhage in cesarean section in Nanjing

Objective To investigate postpartum blood lose of cesarean section (CS) within 24 hrs in Nanjing area Methods Stratified samples were collected from hospitals of different levels and located at different districts The amount of postpartum blood loss was precisely measured by methods of weight, volume and area Results There were 1 125 CS in a total of 4 171 deliveries The main indications for CS were cephalo pelvic disproportion, fetal distress, breech presentation, and there was 10 4% of CS without definite causes The average amount of blood loss was 520 ml in CS, which was far more than that in vaginal delivery ( n = 3 046) If postpartum hemorrhage (PPH) is defined as blood lose of 500ml or more, the incidence of PPH was 53 7%; if it is defined as 700 ml, the incidence was 19 8% Conclusions Cesarean section is an important cause of PPH, and CS without proper indication should be avoided It seems reasonable to defined the criteria of PPH in CS as 700 ml or more