再次剖宫产高龄产妇产后出血危险因素分析

目的:分析再次剖宫产高龄产妇的产后出血(PPH)危险因素,为产后出血的防治提供参考。方法:回顾分析2013年1月至2017年12月在中国医科大学附属盛京医院再次剖宫产的1497例高龄产妇的临床资料。根据是否发生产后出血,将产妇分为产后出血组(131例)与非产后出血组(1366例),分析产妇的年龄、孕产史、胎盘等各类因素与产后出血的相关性,并通过多因素Logistic回归分析筛选出独立危险因素。结果:Logistic回归分析显示,胎盘附着位置(OR=2.15,95%CI为1.17~3.95,P=0.013)、前置胎盘(非前置胎盘:参考组;非完全性前置胎盘:OR=13.85,95%CI为6.22~30.84,P<0.001;完全性前置胎盘:OR=29.32,95%CI为16.32~52.67,P<0.001)和胎盘植入(OR=7.08,95%CI为3.60~13.92,P<0.001)为产后出血的独立危险因素。结论:胎盘附着位置、前置胎盘、胎盘植入为影响再次剖宫产的高龄产妇产后出血的独立危险因素。

Risk factors for postpartum hemorrhage in elderly parturient women undergoing repeated cesarean delivery

Objective:To analyze the risk factors of postpartum hemorrhage(PPH) in elderly parturient women undergoing repeated cesarean delivery,and to provide reference for prevention and treatment of PPH in clinical practice.Methods:A total of 1497 elderly parturient women who underwent repeated cesarean delivery at Shengjing Hospital of China Medical University between Jan.2013 and Dec.2017 were enrolled in our study.According to whether PPH occurred,parturients were divided into PPH group(131 cases) and non-PPH group(1366 cases).The univaritate analysis was carried out between PPH and various factors.Multivariate Logistic regression analysis was adopted to select the independent risk factors.Results:Logistic regression analysis showed that the risk of PPH was higher when placenta attached to the other positions of uterus(OR=2.15,95%CI:1.17~3.95) compared with placenta attached to the posterior wall of uterus.In addition,placenta previa can increase the risk of PPH.The risk of PPH in patients with complete placenta previa(OR=29.32,95%CI:16.32~52.67) was much higher than that in patients with incomplete placenta previa(OR=13.85,95%CI:6.22~30.84).And placenta accreta(OR=7.08,95%CI:3.60~13.92) was also an independent risk factor of PPH.Conclusions:Placental location of attachment,placenta previa and placental accreta are the independent risk factors affecting PPH in elderly parturient women undergoing repeated cesarean delivery.Breech position and transverse position are also closely related to PPH which was rarely reported.