未诊断的产后出血160例临床分析

目的：探讨未诊断的产后出血（undiagnosed postpartum hemorrhage，UDPPH）的发生原因、临床特点、影响因素及预防措施。方法：回顾性分析2013年1月—2017年12月于中国人民解放军第161医院行阴道分娩的产妇1 528例的临床资料，将其分为产后出血（postpartum hemorrhage，PPH）组、UDPPH组和对照组（既无PPH也无UDPPH者），分析UDPPH的临床特点及影响因素，并与PPH组进行比较。结果：阴道分娩中UDPPH和PPH发生率分别为10.5%和6.1%，UDPPH组和PPH组的产前血红蛋白均低于对照组，孕次、总产程时间、第三产程时间、胎盘滞留发生率、会阴损伤发生率均高于对照组，差异有统计学意义（P＜0.05），UDPPH组的初产妇比例、会阴侧切发生率均高于对照组，差异有统计学意义（P＜0.05），而PPH组初产妇比例、会阴侧切发生率与对照组比较差异无统计学意义（P＞0.05），初产妇比例、会阴侧切发生率是UDPPH不同于PPH的影响因素。结论：UDPPH在阴道分娩产妇中很常见，为降低其发生率，需要加强产后观察、正确评估出血量以及针对其影响因素进行预防。

The Clinical Analysis of 160 Cases of Undiagnosed Postpartum Hemorrhage

Objective：To discuss the causes，clinical characteristics, influence factors and preventions of undiagnosed postpartum hemorrhage（UDPPH）． Methods: 1 528 cases of vaginal delivery from January 2013 to December 2017 were retrospectively analyzed，and were divided into three groups: UDPPH group, postpartum hemorrhage (PPH) group and control group(those cases with neither UDPPH nor PPH). The clinical characteristics and influence factors of UDPPH group were analyzed and compared with those of PPH group． Results: The incidence of UDPPH and PPH was 10.5% and 6.1% of vaginal deliveries, respectively. The antepartum hemoglobin of UDPPH group and PPH group were both lower than that of the control group. The gravidity, the total duration of labor, duration of the third stage of labor, the incidence of retained placenta and perineal trauma were all higher than those of the control group (P＜0.05), with statistical differences between them. The rates of primiparity and episiotomy in UDPPH group were higher than those of the control group (P＜0.05), and there were statistical differences between them. But there were no significant differences in the rates of primiparity and episiotomy between PPH group and control group. The rates of primiparity and episiotomy were the influence factors those UDPPH were different from PPH. Conclusions: UDPPH is frequent among women giving birth vaginally. To reduce the incidence，we need to strengthen the observation after delivery，estimate blood loss accurately and prevent it according to the influence factors.