GDM患者产后出血危险因素分析及预防  

Analysis of the risk factors of the postpartum hemorrhage of women with gestational diabetes mellitus and its prevention

作　　者：孙书利[1] 常鸿 岳家伊 王晓莉 王延云 张静[1] SUN Shuli;CHANG Hong;YUE Jiayin;WANG Xiaoli;WANG Yanyun;ZHANG Jing(Liaocheng Second People's Hospital,Shandong Province,252600;Yantai Yeda Hospital;Liaocheng People's Hospital;Liaocheng Dongchangfu District Maternal and Child Health Care Hospital)

机构地区：[1]山东省聊城市第二人民医院,252600 [2]烟台业达医院 [3]山东省聊城市人民医院 [4]山东省聊城市东昌府区妇幼保健院

出　　处：《中国计划生育学杂志》2024年第1期207-211,共5页Chinese Journal of Family Planning

摘　　要：目的:分析妊娠期糖尿病(GDM)患者产后出血(PPH)发生PPH的危险因素,提出对策建议.方法:整群抽样法抽取2021年1月-2023年2月本地区3所医院接收的2984例GDM患者临床资料,根据患者产后24h出血量分为PPH组与非PPH组.收集患者临床资料,采用logistic回归分析模型筛选导致GDM患者PPH的危险因素.结果:2984例GDM患者中539例发生PPH,PPH发生率18.1%.PPH组年龄≥35岁、孕前体质指数(BMI)≥24kg/m^(2)、有刮宫史、有剖宫产史、孕次≥2次、经产、合并妇科炎症、空腹血糖(FBG)≥7mmol/L、胎膜早破、胎盘早剥、胎盘前置、胎盘残留、羊水过多、产程延长、糖化血红蛋白(HbA1c)≥6.5%患者占比均高于非PPH组;多因素logistic回归分析表明,年龄≥35岁、孕前BMI≥24kg/m^(2)、刮宫史、剖宫产史、经产、合并妇科炎症、胎盘早剥、胎盘残留、羊水过多、HbA1c≥6.5%均是导致GDM患者并发PPH的危险因素(均P<0.05).结论:建议临床对年龄≥35岁、孕前BMI≥24kg/m^(2)、有刮宫史、剖宫产史、经产、合并妇科炎症、胎盘早剥、羊水过多GDM患者的加强关注,及时、彻底清除胎盘残留.也提示孕妇控制饮食以控制胎儿体重,降低PPH发生率.Objective:To analyze the risk factors of the postpartum hemorrhage(PPH)occurrence of women with gestational diabetes mellitus(GDM),and to Provide the countermeasure and suggestion.Methods:A cluster sampling method was applied to select the clinical date of 2984 women with GDM admitted to three hospitals from January 2021 to February 2023.These women were divided into study group(women with PPH)and control group(women without PPH)based on their 24-hour postpartum bleeding volume.The clinical data of the women in the two groups were collected.Logistic regression analysis model was used to screen the risk factors leading to PPH of the women with GDM.Results:Among 2984 women with GDM patients,there were 539(18.1%)cases with PPH.The proportions of the age≥35 years old,pre Pregnancy body mass index(BMI)≥24kg/m^(2),history of curettage,history of cesarean section,gravidity≥2 times,multiparity,complicated with gynecological inflammation,fasting blood glucose(FBG)≥7 mmol/L.premature rupture of membranes,placental abruption,placenta previa,placenta residue,polyhydramnios,pro-longed labor and HbAlc≥6.5%of the women in the study group were significantly higher than those of the women in the control group.Multivariate logistic regression analysis showed that the age≥35 years old,the BMI≥>24kg/m^(2) be-fore pregnancy,the history of curettage,the history of cesarean section,the multiparity,the complicated with gyneco-logical inflammation,the placental abruption,the residual placenta,the polyhydramnios and the HbA1c≥6.5%of the women were the risk factors for their PPH occurrence(all P<0.05).Conclusion:The women with GDM and age≥35 years old,prepregnancy BMI≥24kg/m^(2),history of curettage,history of cesarean section,multiparity,complicated with gynecological inflammation,placental abruption,or polyhydramnios should be paid attention to,and their residual placenta should be removed timely and completely.It is also remind that the pregnant women should be control their fetal weight by conrolling their diet,so a

关 键 词：妊娠期糖尿病 产后出血 危险因素 预防 

分 类 号：R714.461[医药卫生—妇产科学]