中央性前置胎盘剖宫产后出血相关因素分析

目的:探讨影响前置胎盘剖宫产产后出血危险因素及相应的预防及临床处理方法.方法:中央性前置胎盘70例,分为剖宫产术中及术后出血≥1000ml的35例作为大出血组,同期手术中及术后出At<1000ml的35例作为对照组,对相关因素进行比较分析.结果:大出血组的孕次和产次均明显多于对照组(P<0.01).大出血组有刮宫史和剖宫产史者所占比例明显高于对照组(P<0.01和0.05).中央性前置胎盘产后出血患者显著多于部分性和边缘性前置胎盘患者(X2=7.041,P<0.01);产后出血>500mL者胎盘面积显著大于出≤500mL者(t=4.723,P<0.01);胎盘附着于子宫前壁者出血量明显多于附着于后壁及侧壁者(t:28.041,P<0.001);流产次数≥2次者产后出血量明显多于流产次数<2次者(t=27.633,P<0.001);产后出血量与年龄无关)r=0.131,t=0.217,P=0.829).结论:剖宫产史、刮宫史(尤其>3次)及前壁胎盘是中央性前置胎盘剖宫产术中及术后大出血的高危因素.

An analysis of related factors of postoperative hemorrhage of women with placenta previa following cesarean section

ObjeetiveTo investigate influencing factors of postoperative hemorrhage(PPH)following cesarean section of wornen with placenta previa,and corresponding prevention and clinical management.Methods There were 70 cases of complete placental previa with PPH were divided into two groups:study group(n=35)which the blood loss of PPH exceeded 1000 ml,contrDl group(n=35),which the blood loss of PPH was less than 1000 ml.The risk factors were analyzed..Results The progesterone prodaetion times in hemorrhage group were significantly higher than the control group(P<0.01);The history of curettage and history of cesarean section in hemorrhage group were significantly higher than the control group(P<0.01 and 0.05);The proportion of pregnant women with central complete)placenta prevm was more than tllat of those pregnant women with incomplete(partial)or marginal placenta previa(X2=7.041,both P<0.01).The greater the placental area,themore the amount of postoperative hemorrhage and the placental area of those pregnant women withmore than 500mL of blood loss after the operation was singifieant larger than thatof those pregnant women with less than 500mLof blood loss(t=4.723,P<0.01).The amount of postoperative hemorrhage of those pregnant women whose placenta was implanted in anteriorwall of the uterus was more than that of those pregnant women whose placenta was implanted the posterior or lateral wall of the uterus(t=28.041,both P<0.001).The amount of plstoperative hemorrhage of those pregnant women with more than or equal two times of induced abortion was higher than thatof those pregnant women with less than two times of induced abortion (t=27.633.P<0.001).There was no relationship between amount of bleeding and age of the pregnant woman (r=0.131,t=0.217,P=0.829).Conehisions History of eesarean section,anterior placenta and parity(especially more than three times)are high-risk factors of massive PPH in complete placental previa.