北京市6194例阴道分娩产后出血影响因素分析  

Analysis of influencing factors of postpartum hemorrhage in 6194 cases of vaginal delivery in Beijing

作　　者：于莹[1] 沈汝冈[1] 刘凯波[1] 杨惠娟[1] YU Ying;SHEN Rugang;LIU Kaibo;YANG Huijuan(Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院,北京100026

出　　处：《中国妇幼健康研究》2023年第10期53-59,共7页Chinese Journal of Woman and Child Health Research

基　　金：首都卫生发展科研专项项目-北京市高危孕产妇管理策略研究与评估(2018-2-2111)。

摘　　要：目的分析阴道分娩产后出血的影响因素,对预防阴道分娩产后出血提供科学依据。方法选取北京市妇幼保健管理信息系统中分娩时间在2022年1月1日至2022年12月31日、孕周≥28周阴道分娩产后出血的产妇6194例为出血组,同期孕周≥28周、阴道分娩无产后出血的产妇71360例为无出血组,对产后出血进行统计分析。结果北京市阴道分娩产后出血发生率为7.99%。单因素分析结果显示出血组与无出血组在年龄、身体质量指数(BMI)、产后出血史、孕次、产次、多胎、妊娠高血压疾病、子宫肌瘤、胎盘因素、分娩前贫血、分娩孕周、巨大儿、死胎、会阴侧切、阴道助产、总产程延长方面差异均有统计学意义(χ^(2)值分别为9.730、117.691、9.093、4.419、189.054、211.420、176.115、7.975、50.866、12.784、127.993、216.439、5.841、140.000、180.000、10.886,P<0.05)。多因素分析结果显示,年龄≥35岁、BMI 25.0~27.9kg/m^(2)、BMI≥28.0kg/m^(2)、产后出血史、孕次≥3次、多胎、妊娠期高血压疾病、胎盘因素、分娩前贫血、分娩孕周≥41周、巨大儿、死胎、会阴侧切、阴道助产是阴道分娩产后出血的危险因素,OR及其95%CI值分别为1.210(1.124~1.302)、1.328(1.212~1.455)、1.284(1.134~1.454)、2.304(1.549~3.427)、1.171(1.079~1.272)、4.172(3.322~5.238)、1.772(1.602~1.959)、3.870(2.599~5.763)、1.197(1.096~1.307)、1.462(1.340~1.595)、2.019(1.811~2.251)、1.667(1.078~2.578)、2.017(1.896~2.145)、2.854(2.642~3.083),P<0.05;BMI<18.5kg/m^(2)、经产妇、早产是阴道分娩产后出血的保护因素,OR及其95%CI值分别为0.747(0.670~0.833)、0.795(0.735~0.859)、0.847(0.735~0.976),P<0.05。结论北京市阴道分娩产后出血发生率较高,加强婚前及孕前保健的健康教育、提升产科与营养科的进一步合作、加强妊娠期间贫血管理、进一步提高助产技能水平等是减少产后出血发生率的重要措施。同时,结合该研究产后Objective To analyze the influencing factors of postpartum hemorrhage in vaginal delivery,and provide a scientific basis for the prevention of postpartum hemorrhage in women with natural delivery.Methods A total of 6194 women with vaginal delivery and postpartum hemorrhage at a gestational age of≥28 weeks from January 1,2022 to December 31,2022 were selected as the hemorrhage group,and 71360 women with a gestational age of≥28 weeks and vaginal delivery without postpartum hemorrhage during the same period were selected as the non-hemorrhage group,and statistical analysis was conducted on postpartum hemorrhage.Results The incidence of postpartum hemorrhage in vaginal delivery in Beijing was 7.99%.The results of univariate analysis showed that there were statistically significant differences between the hemorrhage group and the non-hemorrhage group in age,body mass index(BMI),history of postpartum hemorrhage,pregnancy,parity,multiple births,hypertensive disorders during pregnancy,uterine fibroids,placental factors,prenatal anemia,gestational week at delivery,macrosomia,stillbirth,perineal incision,vaginal delivery,and total labor duration.(χ^(2)=9.730,117.691,9.093,4.419,189.054,211.420,176.115,7.975,50.866,12.784,127.993,216.439,5.841,140.000,180.000 and 10.886,respectively,P<0.05).The results of multivariate analysis showed that age≥35 years old,BMI 25.0-27.9kg/m^(2),BMI≥28.0kg/m^(2),history of postpartum hemorrhage,pregnancy≥3 times,multiple births,hypertensive disorders during pregnancy,placental factors,prenatal anemia,gestational age at delivery≥41 weeks,macrosomia,stillbirth,perineal incision,and vaginal delivery were risk factors for postpartum hemorrhage in vaginal delivery.OR and 95%CI were 1.210(1.124-1.302),1.328(1.212-1.455),1.284(1.134-1.454),2.304(1.549-3.427),1.171(1.079-1.272),4.172(3.322-5.238),1.772(1.602-1.959),3.870(2.599-5.763),1.197(1.096-1.307),1.462(1.340-1.595),2.019(1.811-2.251),1.667(1.078-2.578),2.017(1.896-2.145)and 2.854(2.642-3.083),respectively,P<0.05.BMI<18.5kg/m^(2),mu

关 键 词：孕产妇 阴道分娩 产后出血 影响因素 

分 类 号：R173[医药卫生—妇幼卫生保健]