34864例产后出血危险因素回顾性分析

目的:分析产后出血相关危险因素,探讨预防和减少产后出血的措施。方法:2000年1月1日~2004年12月31日在我院产科分娩的产妇34864例作为观察对象,采用容积法+称重法测量产后出血量,通过二分类变量Logistic回归分析筛选出与产后出血相关的主要危险因素。结果:34864例中,符合产后出血的有1154例,占3.31%,单因素分析中11个因素有统计学意义,多因素分析中有5个因素进入多因素回归模型,分别为子宫收缩乏力(OR=16.248,95%CI14.306~18.809),前置胎盘(OR=11.217,95%CI8.734~14.407),胎盘粘连、植入、滞留(OR=3.116,95%CI2.348~4.134),巨大儿(OR=2.932,95%CI2.426~3.543),剖宫产(OR=1.945,95%CI1.654~2.287)。结论:加强防治宫缩乏力,作好计划生育以减少非意愿妊娠,严格掌握剖宫产指征,减少巨大儿的发生率,对降低产后出血及孕产妇死亡起着重要的作用。

Risk factors for postpartum hemorrhage:a retrospective study of 34864 deliveries.

Objective:To investigate the factors associated with postpartum hemorrhage.Methods:There were 34 864 deliveries in this hospital from 2000 to 2004.The amount of blood loss was measured by the method of weight, volume and range estimation. Postpartum hemorrhage was defined as blood loss ≥500 ml during 24 hours after labor. The binary logistic regression was used in the analysis of risk factors.Results:1 154 cases of postpartum hemorrhage were identified among 34 864 deliveries, the incidence of postpartum hemorrhage being 3.31%. There were 11 factors associated with postpartum hemorrhage significantly according to the single factoral analysis and 5 factors entered the logistic regression model according to multiple factoral analysis. They were uterine inertia (OR=16.248, 95%CI14.306~18.809), placenta previa (OR=11.217, 95%CI8.734~14.407), adherence implantation or residual of placenta (OR=3.116,95%CI2.348~4.134),macrosomia (OR=2.932, 95%CI2.426~3.543), and cesarean section.(OR=1.945,95%CI1.654~2.287).Conclusion:Detecting uterine inertia and applying hysterotonics timely,reducing unwilling pregrancies and induced abortion, controlling fetal weight and the rate of cesarean section are all important to minimize the incidence of postpartum hemorrhage and obstetric mortality.