2000～2005年西安市产后出血导致孕产妇死亡分析

目的 分析与产后出血有关的因素,探讨产后出血的预防.方法 回顾分析53例因产后出血导致的孕产妇死亡病例.结果 产后出血占孕产妇死亡构成比46.1%,为首位死因;产后出血原因单因素占69.8%,多因素22.6%,两者比较P＜0.01,单因素以胎盘因素最多见,为28.3%,宫缩乏力20.8%,两者比较P＞0.05.产后出血的危险因素有病理妊娠、妊娠合并症、催产指征不明确及方法不恰当、产程阻滞;对无血液系统疾病的凝血功能异常导致的产后出血应警惕羊水栓塞;生育年龄偏大、经产妇、经济困难、未按期进行产前检查、非正规人员接产、转诊及诊治延误是产后出血的其他相关因素.结论 加强围产期保健,严格产科技术及人员准入制度,预防及尽早发现、治疗病理妊娠及内外科合并症,严密观察产程,防止滞产,建立产后出血绿色通道及时转诊,积极防冶产后出血.

An analysis of maternal mortality caused by postpartum hemorrhage over a period from 2000 to 2005 in Xi''''an city

Objective By reviewing maternal mortalities caused by postpartum hemorrhage in a six-year period in Xi'an city,to analyze factors related to postpartum hemorrhage and explore its preventions.Methods Data of 53 cases of maternal mortalities caused by postpartum hemorrhage were reviewed.Results The constituent ratio of postpartum hemorrhage for all maternal mortalities was 46.1%,which was the leading cause.For postpartum hemorrhage,69.8% of them were caused by single factors(of which 28.3% of the cases were caused by placental dysfunction,22.8% of the cases were caused by uterine atony),and 22.6% of them were caused by multiple factors.Of which,in single factors,placental factor was the most common cause,accounting for 28.3%,and uterine atony accounted for 20.8%.The risk factors of postpartum hemorrhage included pathologic pregnancy,pregnant complications,pregnancy-associated diseases,undetermined oxytocic indications or inappropriate oxytocic medication methods and prolonged labor,which were of independent prognostic significance for postpartum hemorrhage.For those women who suffered from postpartum hemorrhage without hematological abnormalities or coagulation disorders,the possibility of amnionic fluid embolism(AFE) should be considered.Other factors related to postpartum hemorrhage included elder age of the parturient,multipara,poor,irregularity of antenatal examination,delivered by unskilled medical staff,misdiagnosis and delayed treatment or delayed transport of the severe parturients to the higher level hospital.Conclusion Strengthening perinatal health care,setting up a strict entrance exam system for either obstetric medical staff or technicians,preventing,diagnosing and treating pathological pregnancies and complications early,observing process of labor closely and guarding against prolonged labor,setting up a green pathway of postpartum hemorrhage to transfer the severe parturients to the higher level hospitals are the key and effective methods to prevent and treat postpartum hemorrhage.