影响产后出血危险因素的分析

目的 探讨孕妇产后出血的危险因素，并且进行相关性分析。方法 收集盐城市亭湖区人民医院产科2012年3月至2014年3月住院待产的1000例孕妇，前瞻性观察的时间为产前1个月到产后24h，观察产后出血量以及可能的危险因素，并进行Logistic分析。结果 进入研究的1000例孕妇，研究过程中自动退出12例，生产过程中发生意外疾病或者事故导致不能参加试验的8例，随访结束时共980例，产后24h内出血产妇60例（6．12％），其中500～1000mL27例（45．00％），〉1000—1500mL24例（40．00％），〉1500mL9例（15．00％）。321例剖宫产产后出血者42例（13．08％），659例自然分娩者产后出血者18例（2．73％）。发生宫缩乏力43例（4．38％），胎盘因素30例（3．06％），软产道裂伤20例（2．04％），凝血功能障碍10例（1．02％）。多因素Logistic回归分析显示，患有子宫收缩乏力、胎盘因素、软产道裂伤、凝血功能障碍、血小板减少、前置胎盘的孕妇发生产后出血的可能性分别是凝血功能障碍导致产后出血的3．252、2．344、1．289、0．233、5．411、2．456倍。结论 子宫收缩乏力、胎盘因素、软产道裂伤、凝血功能障碍、分娩胎儿数量、血小板减少、前置胎盘是发生产后出血的主要危险因素，在临床上要加强这些危险因素的预防。

Correlation analysis of risk factors of postpartum hemorrhage

Objective To explore the risk factors of maternal postpartum hemorrhage and conduct correlation analysis. Methods From March 2012 to March 2014 1 000 pregnant women going to delivery in obstetric department of People＇ s Hospital of Tinghu District in Yancheng City were collected. Prospective observation period began one month before childbirth and ended at 24h after childbirth. Postpartum blood loss and possible risk factors were observed and Logistic analysis was conducted. Results Among 1 000 cases recruited, 12 withdrew and 8 exited because of unexpected illness or accident during the production. Totally 980 cases were in the study at the end of follow-up. There were 60 cases of postpartum hemorrhage within 24h after childbirth （6.12%）, including 27 cases with blood loss of 500 -1 000mL （45.00%） , 24 cases with blood loss of 〉 1 000 - 1 500mL （40.00%） and 9 cases with blood loss of more than 1 500mL （15.00%）. Of 321 cases of cesarean section 42 cases suffered postpartum hemorrhage （ 13.08% ） and 18 of 659 cases of natural childbirth suffered postpartum hemorrhage （2.73%）. There were 43 cases of uterine inertia （4.38%）, 30 cases with placental factors （3.06%）, 20 cases with soft birth canal laceration （2.04%） and 10 cases of coagulopathy （1.02%）. Multiple Logistic regression analysis showed that the possibility of postpartum hemorrhage of patients with uterine atony, placental factors, soft birth canal laceration, coagulation disorders, thrombocytopenia, placenta previa was 3. 252 times, 2. 344 times, 1. 289 times, 0. 233 times, 5. 411 times and 2. 456 times, respectively, of that of coagulation disorders. Conclusion Uterine atony, placental factors, soft birth canal laceration, coagulation disorders, number of childbirth, thrombocytopenia and placenta previa are major risk factors of postpartum hemorrhage, so they should be prevented in clinics.