高龄妊娠对产后出血的影响

目的探讨孕妇高龄是否对产后出血产生影响。 方法采用回顾性研究方法对2009年1月1日至2014年12月31日在广州医科大学附属第三医院妇产科住院分娩的年龄≥18岁单胎产妇28 839例的临床资料进行分析，按照孕妇分娩年龄进行分组，≥35岁为高龄组(3 670例)，18～34岁为适龄组(25 169例)，比较两组产后出血发病率、首发病因和妊娠结局；采用独立样本t检验、秩和检验、χ²检验对数据进行统计学分析。 结果本研究总的产后出血发生率为3.75%(1 081/28 839)；高龄组产后出血发病率4.66%(171/3670)，比适龄组产后出血发病率3.62%(910/25 169)高(χ²＝9.673，P＝0.002)。高龄组产后出血首发病因分别为：子宫收缩乏力(55.55%)、胎盘因素(39.77%)、软产道裂伤(3.51%)、凝血功能障碍(1.17%)。高龄组平均住院天数、顺产产后出血量、子宫切除率、转重症监护病房比例、输红细胞比例均高于适龄组，分别为(9.36±0.59)d和(6.42±0.96)d，(799.09±30.55)ml和(742.44±11.34)ml，12.87%和4.51%，5.8%和2.75%，28.65%和17.25%，P均<0.05。 结论高龄妊娠的孕妇更容易发生产后出血，且结局较差，子宫收缩乏力及胎盘因素是主要原因。

Influence of advanced maternal age on postpartum hemorrhage

ObjectiveTo explore the influence of advanced maternal age on postpartum hemorrhage. MethodsClinical data of 28 839 singleton pregnancies, who were ≥18 years old and delivered a baby in The Third Affiliated of Guangzhou Medical University from January 1, 2009 to December 31, 2014 were retrospective analyzed. According to maternal age at delivery, all cases were divided into advanced age group (≥35 years) and appropriate age group (18-34 years). There were 3 670 pregnancies in advanced age group and 25 169 pregnancies in appropriate age group. The incidence of postpartum hemorrhage, initial etiology and pregnant outcome were compared between the two groups. Independent sample t test, rank sum test or Chi-square tests were used for statistical analysis. ResultsThe overall postpartum hemorrhage morbidity was 3.75% (1 081/28 839). The incidence of postpartum hemorrhage in advanced age group was 4.66% (171/3 670), which was higher than that in appropriate age group 3.62% (910/25 169), with χ²=9.673, P=0.002. The initial etiology of postpartum hemorrhage in advanced age group were uterine atony (55.55%), placental factors (39.77%), soft birth canal laceration (3.51%) and coagulation defects (1.17%). The average hospitalization days and the amount of bleeding after vaginal delivery of advanced age group and appropriate age group were (9.36±0.59) d vs. (6.42±0.96) and (799.09±30.55) ml vs. (742.44±11.34) ml; there were significant difference between the two groups (P>0.05). The incidence of uterus resection, shifting to intensive care unit and red cells transfusion in advanced age group were 12.87%, 5.8% and 28.65%, respectively, which were higher than those in appropriate age group (4.51%, 2.75% and 17.25%), all P<0.05. ConclusionsThe pregnancy with advance age is prone to present postpartum hemorrhage, and the pregnancy outcome is poor. Uterine atony and placenta factors may be the main causes.