中国妇幼健康研究2017，Vol.28Issue(12)：1671-1674,4.DOI:10.3969/j.issn.1673-5293.2017.12.054
高龄产妇剖宫产产后出血高危因素分析及术中预防措施探讨
High risk factors and intraoperative prevention measures of caesarean postpartum hemorrhage of elder gravidas
摘要
Abstract
Objective To explore high risk factors and intraoperative preventive measures of postpartum hemorrhage (PPH )after caesarean section (CS) of elder gravidas .Methods A retrospective analysis involved 688 elder gravidas with first elective CS in the First Affiliated Hospital of Xi'an Jiaotong University from January to December 2015 ,including 93 cases of PPH (average blood loss of 1628 .00 ± 206 .60 mL) in study group and 595 cases in control group (average blood loss of 582 .20 ± 150 .30 mL ) .The history ,general situations ,pregnant process ,operation process and pregnancy outcomes were retrospectively analyzed .Logistic regression analysis was conducted to analyze the high risk factors of PPH .According to the results ,58 cases of CS with those high risk factors of PPH visiting the First Affiliated Hospital of Xi 'an Jiaotong University between January and December 2016 were chosen as objects ,and all of the patients received their first CS .Twenty-eight cases were randomly selected in normal group with oxytocin 20u for myometrium injection and oxytocin 20u for intravenous drip after fetal delivery ,and carboprost suppositories 1mg was given in anus before patients were sent out of the operating room .The other 30 cases were in intervention group receiving oxytocin 20u and carboprost tromethamine 250μg for myometrium injection after fetal delivery ,and the rest treatments were same as the normal group .General situations ,incidence of PPH ,blood loss during operation and within 2h after operation ,and side effects were compared between two groups .Results Single factor analysis found that repeated pregnancies (more than 2 ) , gestational hypertension diseases ,pregnancy complicating hepatic disease ,chorioamnionitis ,uterine muscle fibers overstretching , arrested labor ,abnormal placenta and uterine incision laceration were associated with PPH in the CS (OR value was 8 .33 ,5 .22 , 6 .60 ,3 .42 ,10 .12 ,9 .52 ,11 .23 and 6 .40 ,respectively ,all P < 0 .05) .Multivariate Logistic regression analysis carried out on those above factors showed that uterine muscle fibers overstretching ,arrested labor ,abnormal placenta and uterine incision laceration were independent risk factors of PPH (OR value was 6 .47 ,2 .38 ,4 .28 and 1 .33 ,respectively ,all P < 0 .05) .Intervention during operation according to high risk factors revealed that the incidence of PPH ,blood loss during operation and 2h after operation in intervention group were significantly lower than in normal group (t value was 17 .06 ,9 .59 and 5 .28 ,respectively ,all P < 0 .05) . Conclusion PPH of elder gravidas undergoing CS is caused by several factors ,and the major factors include repeated pregnancies (more than 2 ) , gestational hypertension , pregnancy complicating hepatic disease , chorioamnionitis , uterine muscle fibers overstretching ,arrested labor ,abnormal placenta and uterine incision laceration .Uterine muscle fibers overstretching ,arrested labor ,abnormal placenta and uterine incision laceration are independent risk factors with obvious causal relationship with PPH .In the clinical treatment of elder parturients with high risk factors ,carboprost tromethamine with myometrium injections should be used immediately after fetal delivery in the process of CS on the basis of conventional treatments .关键词
高龄产妇/产后出血/危险因素/剖宫产/预防Key words
elder parturient/postpartum hemorrhage (PPH)/risk factor/caesarean section (CS)/prevention分类
医药卫生引用本文复制引用
宗璐,李春芳,黄谱,高丽,薛艳,吕烨,李雪兰..高龄产妇剖宫产产后出血高危因素分析及术中预防措施探讨[J].中国妇幼健康研究,2017,28(12):1671-1674,4.基金项目
国家自然科学基金资助项目(No.81701532),陕西省科技攻关资助项目(No.2015SF124),西安交通大学医学院第一附属医院临床研究课题资助项目(No.XJTU1ARCH2014-029) （No.81701532）
