经阴道分娩产后出血高危因素分析

目的: 分析经阴道分娩产后出血的产前因素, 加强产后出血预防的针对性。方法: 将我院2002年1月—2008年12月间住院经阴道分娩的产后出血产妇116例作为出血组, 选择同期非出血经阴道分娩的产妇116例作为对照组。采用回顾性病例对照研究设计,对比分析116例产后出血病例组和116例对照组有关危险因素的暴露率及结局的差异。结果: 孕次≥3次、经产妇、流产次数≥2次、文化程度较低、妊娠期高血压疾病、贫血、宫缩抑制剂的使用、第三产程≥15分钟、软产道损伤均为高危因素。第一产程和第二产程两组间差异均无统计学意义。经多因素logistic回归分析,软产道损伤、流产≥2次、文化程度低、中重度贫血、妊娠期高血压疾病、第三产程≥15分钟是产后出血的独立高危因素。结论：孕期及早治疗中、重度贫血,积极处理第三产程、促使胎盘在胎儿娩出后15分钟内娩出对于防止产后出血的发生有积极预防作用。

Analysis the Risk factors for postpartum hemorrhage after vaginal delivery

Objective: To analysis prenatal factors of postpartum hemorrhage after vaginal delivery, and to strengthen the specific prevention of postpartum hemorrhage. Method: Among the in-patient cases between the period of January 2002 and December 2008, 116 women with postpartum hemorrhage after vaginal delivery serving as the hemorrhage group, another 116 women without postpartum hemorrhage after vaginal delivery as the control group. Use retrospective case-control study to compare the difference of the exposure rate of risk factor and consequence between the women with postpartum hemorrhage and the control group. Result: High-risk factors included gravida ≥3, multipara, abortion ≥2, low level of education, hypertensive diseases in pregnancy, anemia, use of tocolytics, third stage of labor ≥15min and injury of soft birth canal. Both first stage of labor and second stage of labor have no statistically significant difference. Multiple factors logistic regression analysis showed that the independent risk factors included injury of soft birth, abortion ≥2, low level of education, moderate anemia, hypertensive diseases in pregnancy and third stage of labor ≥15min. Conclusion: Early treatment for moderate and severe anemia in the prenatal period, active management of the third stage of labor and delivery of the placental within 15min after the delivery of fetus can have a preventive effect on postpartum hemorrhage.