摘要
目的探讨阴道分娩即刻产后出血(产后2h内出血)的临床特点及与产程的关系。方法选取2017年1月1日至2021年12月31日在上海交通大学附属第六人民医院产科阴道分娩并发生即刻产后出血的297例患者为观察组,按出血量细分为严重产后出血组(n=78)及轻微产后出血组(n=219),同时选取同期阴道分娩无产后出血(<500mL)的297例患者为对照组,比较各组一般资料、产程及分娩、产后出血原因等。结果观察组中体质量指数(BMI)≥28.00 kg/m^(2)、初产及高危妊娠比例均高于对照组,新生儿体重也高于对照组,差异均有统计学意义(χ^(2)/t值分别为5.274、7.656、11.560、5.109,P<0.05);观察组第二产程、第三产程、总产程均长于对照组,差异有统计学意义(t值分别为2.256、2.769、1.987,P<0.05);观察组产钳助产及巨大儿比例高于对照组,早产比例低于对照组,差异有统计学意义(χ^(2)值分别为29.100、15.006、4.426,P<0.05);与轻微产后出血组相比,严重产后出血组第三产程较长,新生儿体重、产钳助产比例较高,因胎盘因素出血占比较低,手术止血比例较高,差异有统计学意义(χ^(2)/t值分别为2.317、2.752、5.168、4.641、5.610,P<0.05);多因素Logistic回归分析显示,产钳助产、BMI≥28.00 kg/m^(2)、存在合并症/并发症、第三产程较长均是发生产后出血的独立危险因素(OR值介于1.658~4.937之间,P<0.05);相关分析结果显示,第二产程、第三产程及总产程时长与产后出血量具有正相关性,差异有统计学意义(r值分别为0.177、0.113、0.081,P<0.05)。结论第二/三产程延长、体质量指数较大、高危妊娠、产钳助产是产后出血的高危因素,临床应予以重视。
Objective To explore the clinical characteristics of immediate postpartum hemorrhage(postpartum hemorrhage within 2 hours)in vaginal delivery and its relationship with labor process.Methods A total of 297 patients with immediate postpartum hemorrhage during vaginal delivery in department of obstetrics of the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from January 1,2017 to December 31,2021 were selected as the observation group.According to the amount of bleeding,they were divided into the severe postpartum hemorrhage group(n=78)and the mild postpartum hemorrhage group(n=219).At the same time,297 patients without postpartum hemorrhage(<500 mL)during vaginal delivery were selected as the control group.The general data,labor process,delivery and causes of postpartum hemorrhage were compared among the groups.Results The proportions of those with body mass index(BMI)≥28.00 kg/m^(2),primipara and high-risk pregnancy in the observation group were higher than those in the control group,the weight of newborns was also higher than that of the control group,and the differences were statistically significant(χ^(2)/t=5.274,7.656,11.560 and 5.109,respectively,P<0.05).The second stage,third stage and total stage of labor in the observation group were longer than those in the control group,and the differences were statistically significant(t=2.256,2.769 and 1.987,respectively,P<0.05).The proportions of forceps assisted delivery and macrosomia in the observation group were higher than those in the control group,the proportion of preterm birth was lower than that in the control group,and the differences were statistically significant(χ^(2)=29.100,15.006 and 4.426,respectively,P<0.05).Compared with the mild postpartum hemorrhage group,the third stage of labor was longer,the weight of newborns and the proportion of forceps were higher,and the proportion of bleeding due to placental factors was lower,and the proportion of surgical hemostasis was higher in the severe postpartum hemorrhage group,and the
作者
梁爽
蒋荣珍
李毓
顾京红
李婷
冯洁
王娟
金凤
李明
LIANG Shuang;JIANG Rongzhen;LI Yu;GU Jinghong;LI Ting;FENG Jie;WANG Juan;JIN Feng;LI Ming(The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University,Shanghai Critical Maternal Rescue Center,Research Institute of Obstetrics and Gynecology,The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)
出处
《中国妇幼健康研究》
2022年第6期38-43,共6页
Chinese Journal of Woman and Child Health Research
基金
上海申康医院发展中心项目(SHDC2020CR6021)。
关键词
阴道分娩
产后出血
产程
体质量指数
vaginal delivery
postpartum hemorrhage
labor process
body mass index
