阴道试产失败中转剖宫产产妇产后出血影响因素分析及风险预测模型建立  

Analysis of influencing factors of postpartum hemorrhage in pregnant women converted to cesarean section due to failed vaginal trial delivery and establishment of a risk prediction model

作　　者：李星[1] 蔡霞 费云[1] 许勤[2] LI Xing;CAI Xia;FEI Yun;XU Qin(Operating Room,Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University,Wuxi Jiangsu 214002;School of Nursing,Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]南京医科大学附属无锡市妇幼保健院手术室,江苏无锡214002 [2]南京医科大学护理学院,南京211166

出　　处：《临床与病理杂志》2022年第9期2166-2173,共8页Journal of Clinical and Pathological Research

摘　　要：目的:分析阴道试产失败中转剖宫产产妇产后出血的影响因素,为预防和减少产后出血的发生提供依据。方法:本研究为回顾性研究,选取于2019年7月至2020年3月在无锡市妇幼保健院阴道试产失败中转剖宫产的330例产妇作为研究对象,依据是否发生产后出血将产妇分为产后出血组(n=43)与非产后出血组(n=287),收集产妇的临床资料并进行统计分析。结果:阴道试产失败中转剖宫产产妇产后出血的发生率为13%。单因素分析结果显示:阴道试产失败中转剖宫产产妇发生产后出血与产妇年龄、新生儿出生体重、试产时间、术前宫口、术前血红蛋白值、生育史、新生儿有产瘤、应用分娩镇痛、发生子宫下段及宫颈水肿、子宫切口撕裂、胎盘粘连有关(P<0.05)。多因素分析结果显示:新生儿出生体重≥3 795 g、试产时间≥10 h、子宫下段及宫颈水肿、子宫切口撕裂是产妇发生产后出血的危险因素,分娩镇痛是产妇发生产后出血的保护因素。阴道试产失败中转剖宫产产后出血预测模型受试者工作特征(receiver operating characteristic,ROC)曲线分析曲线下面积(area under thecurve,AUC)为0.915,95%CI为0.867~0.962,灵敏度为0.837,特异度为0.871。结论:当胎儿体重>3 795 g,试产时间≥10 h,软产道发生水肿时提示产后出血风险较高,建议及早终止试产中转剖宫产。运用本研究所得模型预测值大于-11.651时,术中应警惕子宫切口撕裂以减少阴道试产失败中转剖宫产产妇产后出血的发生。Objective: To analyze the influencing factors of postpartum hemorrhage in women transferred to cesarean section due to failure of vaginal trial delivery, so as to provide basis for prevention and reduction of postpartum hemorrhage. Methods: This study retrospectively selected 330 puerperae who were transferred to cesarean section in Wuxi Maternity and Child Health Care Hospital from July 2019 to March 2020 after unsuccessful vaginal trial delivery as the research subjects. They were divided into a postpartum hemorrhage group(n=43) and a non-postpartum hemorrhage group(n=287). The clinical data of puerpera were collected and analyzed statistically. Results: The incidence of postpartum hemorrhage was 13%. The results of univariate analysis showed that postpartum hemorrhage was related to maternal age, neonatal birth weight, trial delivery time, preoperative uterine orifice, preoperative hemoglobin value, delivery times, neonatal tumor, application of labor analgesia, lower uterine segment and cervical edema, uterine incision tear and placental adhesion(P<0.05). The results of multivariate analysis showed that the risk factors of postpartum hemorrhage were neonatal birth weight ≥3 795 g, trial production time ≥10 h, lower uterine segment and cervical edema, uterine incision tear, labor analgesia is a protective factor for postpartum hemorrhage. The area under the receiver operating characteristic(ROC) curve(AUC) of the prediction model of postpartum hemorrhage converted to cesarean section a?ter vaginal trial failure was 0.915, 95%CI was 0.867 to 0.962, the sensitivity was 0.837 and the specificity was 0.871. Conclusion: When the fetal weight is more than 3 795 g, the vaginal trial delivery time is more than 10 h, and the edema of the so?t birth canal indicates that the risk of postpartum hemorrhage is high. It is suggested to terminate the trial delivery as soon as possible and convert to cesarean section. When the predicted value of the model obtained in this study is greater than-11.651, we should be vigilant

关 键 词：阴道试产 产后出血 影响因素 预测模型 

分 类 号：R714.461[医药卫生—妇产科学]