黄河三角洲地区产后出血病例的回顾性分析

A Retrospective Analysis of Cases of Postpartum Hemorrhage in the Yellow River Delta Region

摘要: 目的：回顾性分析影响产后出血的相关因素、产后出血的病因及处理措施，为临床产后出血的预防、处理提供依据。方法：通过病案病例系统收集自2014年1月1日至2020年1月1日于滨州医学院附属医院就诊分娩的孕妇42,090人，发生产后出血的产妇1962例，将其设为病例组，选取同期未发生产后出血的1800例设为对照组，对以下指标进行统计学分析：年龄、身高、体重、孕周、居住地、职业、分娩方式、临产方式、分娩镇痛情况、胚胎移植情况、保胎史、妊娠次数、剖宫产次数、经阴分娩次数、流产次数、胎儿体重、妊娠合并症、出血量、分娩前后血红蛋白量、输血量、出血原因、高危因素、产后出血的处理方式、产妇结局。结果：1) 我院2014年1月~2020年1月的总分娩量42,090例，产后出血率4.66%：其中剖宫产产后出血率5.80%，经阴分娩产后出血率3.27%，两者比较有统计学意义(P < 0.05)。2) 病例组与对照组的产妇在孕周、年龄、流产次数、剖宫产次数方面的差异具有统计学意义(P < 0.05)，而在BMI、经阴分娩次数方面的差异无统计学意义(P > 0.05)。3) 病例组与对照组的产妇在居住地、职业、分娩方式、是否胚胎移植、是否有保胎病史方面的差异有统计学意义(P < 0.05)；两组产妇在是否自然临产、是否行分娩镇痛方面的差异无统计学意义(P > 0.05)。4) 病例组与对照组的产妇在是否是瘢痕子宫、妊娠期高血压、妊娠合并贫血、前置胎盘、胎盘早剥、重度子痫前期、双胎妊娠、巨大儿方面的差异均具有统计学意义(P < 0.05)，而在是否是妊娠期糖尿病方面的差异无统计学意义(P > 0.05)。5) 通过多因素Logistic回归分析：孕周是影响产后出血的独立保护因素；年龄、胎盘早剥、巨大儿、保胎病史是产后出血的独立危险因素。6) 产后出血致子宫切除17例，子宫切除率0.040%。结论：1) 剖宫产产后出血发生率高于经阴分娩产后出血发生率。随着流产次数及剖宫产次数的增加，产后出血的发生率也增加。子宫收缩乏力和胎盘因素(前置胎盘、胎盘黏连、胎盘植入)是影响产后出血的主要原因。2) 瘢痕子宫、妊娠期高血压、妊娠合并贫血、前置胎盘、胎盘早剥、重度子痫前期、双胎妊娠、巨大儿会增加产后出血发生率，妊娠期糖尿病对产后出血发生率无明显影响。3) 孕周、年龄、胎盘早剥、巨大儿、保胎病史均是产后出血的独立影响因素，其中孕周是影响产后出血的独立保护因素：早产会增加产后出血的发生率。年龄、胎盘早剥、巨大儿、保胎病史是影响产后出血的独立危险因素。孕妇是否自然临产、是否行分娩镇痛对产后出血发生率无明显影响，从而提醒产科医生要积极开展无痛分娩。

Abstract: Objective: To retrospectively analyze the related influencing factors, causes and treatment measures of postpartum hemorrhage, and provide a basis for the prevention and treatment of postpartum hemorrhage in clinical practice. Methods: Through the medical record system, 42,090 pregnant women who delivered at Binzhou Medical University Hospital from January 1, 2014 to January 1, 2020 were collected. Among them, 1962 cases of postpartum hemorrhage were selected as the case group, and 1800 cases without postpartum hemorrhage during the same period were selected as the control group. The following indicators were statistically analyzed: age, height, weight, gestational age, place of residence, occupation, mode of delivery, mode of labor, labor analgesia, embryo transfer, history of pregnancy maintenance, number of pregnancies, number of cesarean sections, number of vaginal deliveries, number of abortions, fetal weight, pregnancy complications, blood loss, hemoglobin levels before and after delivery, blood transfusion volume, causes of bleeding, high-risk factors, treatment methods for postpartum hemorrhage, and maternal outcomes. Results: 1) The total number of deliveries in our hospital from January 2014 to January 2020 was 42,090, with a postpartum hemorrhage rate of 4.66%. The postpartum hemorrhage rate after cesarean section was 5.80%, and the postpartum hemorrhage rate after vaginal delivery was 3.27%. The difference was statistically significant (P < 0.05). 2) There were statistically significant differences in gestational age, age, number of abortions, and number of cesarean sections between the case group and the control group (P < 0.05), while there were no statistically significant differences in BMI and number of vaginal deliveries (P > 0.05). 3) There were statistically significant differences in place of residence, occupation, mode of delivery, whether embryo transfer was performed, whether there was a history of pregnancy maintenance, and whether there was puerperal infection between the case group and the control group (P < 0.05); there were no statistically significant differences in whether labor was natural and whether labor analgesia was performed (P > 0.05). 4) There were statistically significant differences in whether there was a scarred uterus, gestational hypertension, pregnancy anemia, placenta previa, placental abruption, severe preeclampsia, twin pregnancy, and macrosomia between the case group and the control group (P < 0.05), while there was no statistically significant difference in whether there was gestational diabetes (P > 0.05). 5) Through multivariate Logistic regression analysis: gestational age was an independent protective factor for postpartum hemorrhage; age, placental abruption, macrosomia, and history of pregnancy maintenance were independent risk factors for postpartum hemorrhage. 6) There were 17 cases of hysterectomy due to postpartum hemorrhage, with a hysterectomy rate of 0.040%. Conclusion: 1) The incidence of postpartum hemorrhage after cesarean section is higher than that after vaginal delivery. With the increase in the number of abortions and cesarean sections, the incidence of postpartum hemorrhage also increases. Uterine atony and placental factors (placenta previa, placental adhesion, placenta accreta) are the main causes of postpartum hemorrhage. 2) Scarred uterus, gestational hypertension, pregnancy anemia, placenta previa, placental abruption, severe preeclampsia, twin pregnancy, and macrosomia increase the incidence of postpartum hemorrhage, while gestational diabetes has no significant effect on the incidence of postpartum hemorrhage. 3) Gestational age, age, placental abruption, macrosomia, and history of pregnancy maintenance are independent influencing factors for postpartum hemorrhage, among which gestational age is an independent protective factor for postpartum hemorrhage: preterm birth increases the incidence of postpartum hemorrhage. Age, placental abruption, macrosomia, and history of pregnancy maintenance are independent risk factors for postpartum hemorrhage. Whether labor is natural or whether labor analgesia is performed has no significant effect on the incidence of postpartum hemorrhage, thus reminding obstetricians to actively promote painless delivery.