宫缩乏力性产后出血的相关因素研究

目的 探究自然分娩初产妇宫缩乏力性产后出血的相关因素。方法 选择2009年6月至2013年6月于扬州市江都妇幼保健院产科经阴道自然分娩的产妇860名，其中20名出现宫缩乏力性产后出血者作为出血组，其余840名未出现宫缩乏力性产后出血者为对照组。通过调查问卷的方式收集产妇的资料，并分析自然分娩初产妇宫缩乏力性产后出血的影响因素。结果 单因素分析发现，高龄产妇、妊娠次数≥3次、流产次数≥2次、妊娠合并糖尿病或高血压、分娩紧张、第三产程≥15min、胎儿性别为女性、贫血的自然分娩初产妇宫缩乏力性产后出血的发生率较高，母婴早接触吸吮产后出血的发生率较低，两组比较差异均有统计学意义（χ^2分别为14．282、15．108、20．641、7．393、3．907、19．456、8．252、10．640和12．968，均P＜0．05）。多因素分析发现，高龄产妇、妊娠次数、流产次数、妊娠合并高血压、分娩紧张、第三产程长、胎儿为女性、贫血是自然分娩初产妇宫缩乏力性产后出血的危险因素（Waldχ^2分别为6．955、6．037、13．096、20．474、5．224、19．089、17．254和9．617，均P＜0．05），而母婴早接触吸吮是保护因素（OR＝0．072，95％CI：0．025～0．208）。结论 阴道分娩初产妇宫缩乏力性产后出血的发生受妊娠次数、流产次数、妊娠合并高血压等多种因素的影响，因此应针对各种因素进行干预，有效地预防产妇宫缩乏力性产后出血的发生，改善产妇预后。

Influencing factors of postpartum hemorrhage caused by uterine inertia

Objective To explore the influencing factors of postpartum hemorrhage caused by uterine inertia of natural labor primipara . Methods Totally 860 primiparas of vaginal delivery during the period of June 2009 to June 2013 in Jiangdu Maternity and Child Care Hospital of Yangzhou were selected .Twenty of them with postpartum hemorrhage caused by uterine inertia were recruited in hemorrhage group, and the others were recruited in control group .Questionnaire survey was conducted to collect the data of primiparas and analyze the influencing factors of postpartum hemorrhage caused by uterine inertia of natural labor primipara .Results Single factor analysis revealed that elderly parturient women , number of pregnancies≥3, number of abortion≥2, pregnancy associated with diabetes or hypertension , labor tension, the third stage of labor≥15 minutes, female fetus and anemia enhanced the incidence of postpartum hemorrhage caused by uterine inertia of natural labor primipara , while the incidence of postpartum hemorrhage was relatively low at early maternal and fetal contact and sucking of natural labor primipara .The differences between two groups were significant （χ^2value was 14.282, 15.108, 20.641, 7.393, 3.907, 19.456, 8.252, 10.640 and 12.968, respectively, all P〈0.05）.Multivariate analysis indicated that elderly parturient women , number of pregnancy , number of abortion , pregnancy associated with hypertension , labor tension , long third stage of labor, female fetus and anemia were risk factors of postpartum hemorrhage caused by uterine inertia of natural labor primipara （ Wald χ^2value was 6.955, 6.037, 13.096, 20.474, 5.224, 19.089, 17.254 and 9.617, respectively, all P〈0.05）, while early maternal and fetal contact and sucking was protective factor （OR=0.072,95%CI：0.025-0.208）.Conclusion The postpartum hemorrhage caused by uterine inertia of vaginal delivery primiparas is influenced by number of pregnancy , number of abortion , pregnancy associated with hypertension, and etc.Therefore, all