胎盘植入性疾病剖宫产患者严重产后出血的危险因素分析  

Analysis of risk factors of severe postpartum hemorrhage in patients with placenta accreta spectrum disorders and cesarean section

作　　者：黄欣欣[1] 李莉[2] 王金吉[3] HUANG Xinxin;LI Li;WANG Jinji(Department of Health Care,Women and Children Clinical School of Medicine,Fujian Medical University,Fujian Maternal and Child Health Hospital,Fuzhou 350001,China;Department of Obstetrics,Women and Children Clinical School of Medicine,Fujian Medical University,Fujian Maternal and Child Health Hospital,Fuzhou 350001,China;Department of Comprehensive Information,Women and Children Clinical School of Medicine,Fujian Medical University,Fujian Maternal and Child Health Hospital,Fuzhou 350001,China)

机构地区：[1]福建省妇幼保健院,福建医科大学妇儿临床医学院保健部,福建福州350001 [2]福建省妇幼保健院,福建医科大学妇儿临床医学院产科,福建福州350001 [3]福建省妇幼保健院,福建医科大学妇儿临床医学院综合信息科,福建福州350001

出　　处：《沈阳医学院学报》2022年第6期591-594,共4页Journal of Shenyang Medical College

基　　金：福建省卫生健康中青年骨干人才培养项目(No.2019-ZQN-21)。

摘　　要：目的:探讨胎盘植入性疾病剖宫产患者严重产后出血的危险因素。方法:选取2015年1月至2020年12月我院收治的单胎妊娠,出院诊断为胎盘植入性疾病合并产后出血的剖宫产患者共152例,按照产后出血量分组,出血量≥1500 ml患者为研究组,出血量<1500 ml患者为对照组,单因素分析引起产后出血的危险因素(胎盘植入性疾病分型、流产次数、既往剖宫产次数、入院血红蛋白、孕次、产前出血状况、合并妊娠期高血压疾病、前置胎盘、孕周及产次),将单因素差异有统计学意义的高危因素进行多因素Logistic分析,评估胎盘植入性疾病剖宫产患者严重产后出血的危险因素。结果:研究组和对照组胎盘植入性疾病分型、入院血红蛋白、是否合并前置胎盘差异有统计学意义(P<0.05)。多因素Logistic分析发现仅入院血红蛋白<110 g/L(OR=2.288,95%CI:1.165~4.494,P=0.016)和胎盘植入性疾病合并前置胎盘(OR=2.798,95%CI:1.330~5.886,P=0.007)是严重产后出血的危险因素。结论:临床上应积极干预入院血红蛋白<110 g/L和胎盘植入性疾病合并前置胎盘孕产妇,防止严重产后出血的发生。Objective:To analyze the risk factors of severe postpartum hemorrhage in patients with placenta accreta spectrum disorders and cesarean section.Methods:A total of 152 cases of cesarean section diagnosed as placenta accreta spectrum disorders and postpartum hemorrhage were selected from singleton pregnancies admitted to our hospital from Jan 2015 to Dec 2020.Patients with hemorrhage≥1500 ml were selected as the study group and patients with hemorrhage<1500 ml were selected as the control group.Univariable and multivariable analysis were performed to evaluate the risk factors of severe postpartum hemorrhage(type of placenta accreta spectrum disorders,number of miscarriages,number of previous cesarean sections,admission hemoglobin,number of pregnancies,prenatal hemorrhage,pregnancy-induced hypertension,placenta previa,gestational age and parity)in patients with placenta accreta spectrum disorders and cesarean section.Results:There were statistically significant differences in the type of placenta accreta spectrum disorders,admission hemoglobin and placenta previa between the study group and the control group(P<0.05).Multivariable logistic analysis found that only admission hemoglobin<110 g/L(OR=2.288,95%CI:1.165-4.494,P=0.016)and placenta accreta spectrum disorders combined with placenta previa(OR=2.798,95%CI:1.330-5.886,P=0.007)were risk factors for severe postpartum hemorrhage.Conclusion:Admission hemoglobin<110 g/L and placenta accreta spectrum disorders combined with placenta previa are the risk factors for severe postpartum hemorrhage,which should be actively intervened in clinical practice.

关 键 词：胎盘植入性疾病 前置胎盘 剖宫产 严重产后出血 

分 类 号：R719.8[医药卫生—妇产科学]