剖宫产未诊断的产后出血现状及影响因素研究

黄楠; 陈香军; 徐丽燕; 裘雅芬

doi:10.16766/j.cnki.issn.1674-4152.002772

剖宫产未诊断的产后出血现状及影响因素研究

doi: 10.16766/j.cnki.issn.1674-4152.002772

杭州师范大学附属医院产科，浙江杭州 310015

基金项目:

浙江省医药卫生科技计划项目 2019KY498

详细信息

通讯作者:
黄楠，E-mail：deligugu@163.com

中图分类号: R719.82 R714.461
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- 文章访问数: 173
- HTML全文浏览量: 41
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-11
- 网络出版日期: 2023-02-07

Status and influencing factors of undiagnosed abnormal postpartum blood loss during caesarean section

Department of Obstetrics, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的分析剖宫产未诊断的产后出血(UPPBL)现状及其相关影响因素。方法回顾性分析2019年1月—2020年6月于杭州师范大学附属医院住院并行剖宫产的415例产妇的临床资料，根据产后出血(PPH)和UPPBL的定义将其分为PPH组13例、UPPBL组41例和未发生产后出血组(对照组)361例。比较3组一般临床资料和剖宫产前1周内、剖宫产后第2天的Hb水平，分析影响剖宫产UPPBL的相关因素。结果 415例产妇UPPBL的发生率为9.88%(41例)；UPPBL组和PPH组在年龄、孕次、产次、早产比例、妊娠高血压发生率、胎盘粘连发生率等方面均明显高于对照组(均P < 0.05)；UPPBL组年龄明显高于PPH组，而孕次明显低于PPH组(均P < 0.05)。3组剖宫产前1周内Hb水平差异无统计学意义(P>0.05)，UPPBL组和PPH组剖宫产后第2天Hb水平均明显低于对照组(均P < 0.05)，2组剖宫产前与剖宫产后Hb水平变化明显高于对照组(P < 0.05)；年龄、孕次、产次、妊娠高血压、胎盘粘连、早产是影响UPPBL的因素。结论 UPPBL在剖宫产产妇的发病率较高，年龄、孕次、产次、妊娠高血压、胎盘粘连、早产是影响剖宫产产妇发生UPPBL的因素，临床应采取相关措施以降低UPPBL的发生风险。
- 剖宫产 /
- 未诊断的产后出血 /
- 产后出血 /
- 危险因素
Abstract: Objective To analyse the status of undiagnosed abnormal postpartum blood loss (UPPBL) during caesarean section and related influencing factors. Methods The clinical data of 415 women with caesarean section who were hospitalised in Affiliated Hospital of Hangzhou Normal University from January 2019 to June 2020 were retrospectively analysed. Based on the definition of postpartum haemorrhage (PPH) and UPPBL, they were divided into PPH (n=13), UPPBL (n=41) groups and the control group (n=361) without postpartum haemorrhage. The general clinical data of the three groups were compared with the level of haemoglobin (Hb) in the first week before caesarean section and the second day after caesarean section, and the related factors affecting UPPBL in caesarean section were analysed. Results The incidence of UPPBL in 415 parturients was 9.88% (41 cases). Compared with the control group, the UPPBL and PPH groups showed significantly higher values in terms of age, gestational order, delivery order, proportion of premature delivery, incidence of hypertension during pregnancy, incidence of placental adhesion and other aspects (all P < 0.05). The age of UPPBL group was significantly higher than that of the PPH group, but the number of pregnancies was significantly lower (all P < 0.05). No significant difference was observed in the Hb level between the three groups 1 week before the caesarean section (P>0.05). The Hb level in UPPBL and PPH groups on the second day after caesarean section was significantly lower than that in the control group (all P < 0.05), and the Hb level before and after caesarean section in the two groups was significantly higher than that in the control group (P < 0.05). Age, gestational order, delivery order, gestational hypertension, placental adhesion and premature delivery were influence factors that affected UPPBL. Conclusion The incidence of UPPBL is high in women who deliver by caesarean section. Age, gestational order, delivery order, gestational hypertension, placental adhesion and premature delivery are influence factors affecting the occurrence of UPPBL in women who deliver by caesarean section. Relevant measures should be implemented clinically to reduce the risk of UPPBL.
- Caesarean section /
- Undiagnosed abnormal postpartum blood loss /
- Postpartum hemorrhage /
- Risk factor

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表 1 3组产妇一般临床资料比较

Table 1. Comparison of general clinical data of three groups of parturient women

组别	例数	年龄 (x±s, 岁)	孕次 (x±s, 次)	产次 (x±s, 次)	妊娠高血压 [例(%)]	妊娠糖尿病 [例(%)]	胎盘粘连 [例(%)]
对照组	361	29.17±2.68	1.25±0.63	0.35±0.12	21(6.29)	41(11.36)	19(5.26)
PPH组	13	30.90±2.73^a	1.95±0.73^a	0.68±0.17^a	4(21.05)^a	2(15.38)	3(23.08)^e
UPPBL组	41	33.00±2.85^ab	1.54±0.61^ab	0.62±0.19^a	14(22.58)^a	5(12.20)	10(24.39)^e
统计量		38.640^c	10.990^c	113.299^c	41.903^d	0.217^d	23.381^d
P值		< 0.001	< 0.001	0.001	< 0.001	0.897	< 0.001

组别	例数	早产[例(%)]	巨大胎儿[例(%)]	新生儿BMI(x±s)		子宫瘢痕[例(%)]	延期妊娠[例(%)]
对照组	361	21(5.82)	48(13.30)	13.24±1.75		46(12.74)	21(5.82)
PPH组	13	3(23.08)^e	2(15.38)	13.27±1.67		2(15.38)	1(7.69)
UPPBL组	41	10(24.39)^e	6(14.63)	13.31±1.69		5(12.20)	3(7.31)
统计量		20.839^d	0.098^d	0.031^c		0.092^d	0.212^d
P值		< 0.001	0.952	0.969		0.955	0.899
注：与对照组比较，^aP < 0.01；与PPH组比较，^bP < 0.05；与对照组比较，^eP < 0.017；^c为F值，^d为χ²值。3组计数资料比较，校正检验水准α′=0.017。

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表 2 3组产妇Hb水平比较[M(P₂₅, P₇₅), g/L]

Table 2. Comparison of Hb levels among 3 groups of parturients[M(P₂₅, P₇₅), g/L]

组别	例数	产前1周内	产后第2天	Hb水平变化量
对照组	361	122.5(115.5, 128.7)	116.9(107.5, 125.2)	8.6(7.1, 13.4)
PPH组	13	124.7(112.5, 131.4)	87.9(82.6, 95.7)^a	29.7(25.7, 41.5)^a
UPPBL组	41	122.9(113.7, 129.8)	83.8(79.5, 92.4)^a	31.9(28.4, 45.6)^a
H值		0.723	26.989	-7.983
P值		0.879	< 0.001	0.023
注：与对照组比较，^aP < 0.05。

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表 3 影响产妇发生UPPBL的相关因素赋值

Table 3. Assignment of related factors affecting maternal UPPBL

变量	赋值方法
年龄	以实际值赋值
孕次	以实际值赋值
产次	以实际值赋值
妊娠高血压	无=0，有=1
胎盘粘连	无=0，有=1
早产	无=0，有=1
UPPBL	未发生=0，发生=1

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表 4 影响产妇发生UPPBL的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of influencing maternal UPPBL

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	1.728	0.387	5.326	0.021	5.628	2.636~12.216
孕次	0.912	0.365	4.926	0.026	2.489	1.217~5.090
产次	1.336	0.661	9.891	0.002	3.803	1.041~13.892
早产	0.912	0.365	4.926	0.026	2.489	1.217~5.090
妊娠高血压	1.556	0.652	9.793	0.002	4.739	1.321~17.007
胎盘粘连	1.661	0.358	5.496	0.019	5.264	2.610~10.617

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