摘要
目的:探讨阴道试产失败中转剖宫产产后出血的影响因素.方法:回顾性分析2020年6月-2021年12月期间本院产科阴道试产失败中转剖宫产的397例产妇临床资料,根据有无发生产后出血,分为产后出血组(n=38)和非产后出血组(n=359),通过多因素logistic回归分析阴道试产失败中转剖宫产产后出血的影响因素.结果:397例产妇发生产后出血38例(占9.6%),多因素logistic回归分析结果显示,试产时间长(OR=6.450,95%CI2.427~10.635)、子宫下段及宫颈水肿(OR=5.168,95%CI1.563~6.948)、切口撕裂(OR=8.016,95%CI2.725~12.130)、凝血功能障碍(OR=3.020,95%CI1.758~7.322)、新生儿体重(OR=5.037,95%CI2.014~9.386)是阴道试产失败中转剖宫产产后出血的危险因素(P<0.05),分娩镇痛(OR=0.201,95%CI0.108~0.514)是发生产后出血的保护因素(P<0.05).结论:孕期监测并合理控制胎儿体重,正确把握试产时间,科学运用分娩镇痛,产程中动态评估产程进展以预防或减少软产道水肿发生,警惕术中子宫切口撕裂的发生,有助于预防或减少阴道试产失败中转剖宫产产后出血的发生.
Objective: To analyze the influencing factors of postpartum hemorrhage in pregnant women who failed vaginal trial delivery and converted to cesarean section. Methods: The clinical data of 397 pregnant women who failed vaginal trial delivery and converted to cesarean section from June 2020 to December 2021 were selected retrospectively. According to whether postpartum hemorrhage occurred or not, these women were divided into group A(38 women with postpartum hemorrhage) and group B(359 women without postpartum hemorrhage). The influencing factors of postpartum hemorrhage of the women in group A were analyzed by multivariate logistic regression. Results: There were 38(9.6%) women with postpartum hemorrhage in 397 women. Multivariate logistic regression analysis showed that long time of vaginal trial delivery(OR =6.450, 95%CI 2.427-10.635), the edema of lower segment of uterus and cervix(OR=5.168 95%CI 1.563-6.948), the incision tear(OR=8.016, 95%CI 2.725-12.130), the coagulation disorders(OR=3.020, 95%CI 1.758-7.322), the neonatal weight(OR=5.037, 95%CI 2.014-9.386) of the women who had been converted to cesarean section after vaginal trial delivery failure were the risk factors of their postpartum hemorrhage(P<0.05), and labor analgesia(OR=0.201, 95%CI 0.108-0.514) was a protective factor of their postpartum hemorrhage(P<0.05). Conclusion: Some measure, such as monitoring and reasonably controlling fetal weight during pregnancy, correctly grasping the trial delivery time, scientifically using labor analgesia, and dynamically evaluating the progress of labor in the process of labor, can prevent or reduce the occurrence of the edema of soft birth canal, and can alert the occurrence of intraoperative uterine incision tear, which is helpful to prevent or reduce the occurrence of postpartum hemorrhage of the pregnant women who have failed vaginal trial delivery and converted to cesarean section.
作者
陈晓运
汪柏云
胡春仙
蔡锋成
CHEN Xiaoyun;WANG Baiyun;HU Chunxian;CAI Fengcheng(Hangzhou Obstetrics and Gynecology Hospital,Hangzhou,Zhejiang Province,310007)
出处
《中国计划生育学杂志》
2022年第10期2382-2385,共4页
Chinese Journal of Family Planning
关键词
试产失败
中转剖宫产
产后出血
影响因素
Failure of vaginal trial delivery
Converted to cesarean section
Postpartum hemorrhage
Influencing factors
