GDM产妇阴道试产失败转剖宫产产后出血的影响因素分析  

Analysis of factors influencing postpartum hemorrhage in gestational diabetes mellitus puerpera with failed vaginal trial and conversion to cesarean section

作　　者：许娟 汤敬敬 蔡锋成 XU Juan;TANG Jingjing;CAI Fengcheng(Department of Obstetrics,Hangzhou Obstetrics and Gynecology Hospital,Hangzhou 310008,China)

机构地区：[1]杭州市妇产科医院产科,浙江杭州310008

出　　处：《全科医学临床与教育》2025年第3期223-226,共4页Clinical Education of General Practice

基　　金：浙江省医药卫生科技计划项目(2023KY204)。

摘　　要：目的 探讨妊娠期糖尿病(GDM)产妇阴道试产失败转剖宫产产后出血(PPH)的相关危险因素。方法 收集阴道试产失败转剖宫产手术的376例GDM产妇病历资料,根据是否发生PPH,分为非PPH组(n=340)和PPH组(n=36),采用单因素分析及多因素logistic回归模型筛查GDM产妇阴道试产失败转剖宫产后发生PPH的独立危险因素。结果 不同年龄、孕前体重指数(BMI)、糖化血红蛋白(HbA1c)、瘢痕子宫、妊娠期高血压、产前纤维蛋白原水平、胎盘粘连、合并妇科炎症、分娩镇痛、巨大儿、切口撕裂的GDM产妇转剖宫产PPH发生情况存在明显差异(χ^(2)分别=4.99、8.29、65.46、12.32、9.71、7.05、6.51、4.73、9.71、9.79,P均<0.05),PPH组术前宫口扩张程度、试产时长均高于非PPH组,差异均有统计学意义(t分别=2.09、3.70,P均<0.05)。logistic回归分析显示,孕前BMI>28 kg/m^(2)、HbA1c≥7%、瘢痕子宫、产前纤维蛋白原≤3 g/L、试产时间长、巨大儿、子宫切口撕裂是GDM产妇阴道试产失败转剖宫产后发生PPH的独立危险因素(OR分别=1.68、5.98、2.55、3.82、4.57、3.10、2.32,P均<0.05)。结论 GDM产妇阴道试产失败转剖宫产发生PPH与孕前高BMI、纤维蛋白原减少、高HbA1c、试产时间长、瘢痕子宫、巨大儿及切口撕裂等因素有关。Objective To explore the related risk factors of postpartum hemorrhage(PPH)in pregnant women with diabetes mellitus(GDM)after vaginal trial delivery failure and coversion to cesarean section.Methods The medical records of 376 women with GDM who underwent vaginal trial failure and coversion to cesarean section operation were collected.According to whether PPH occurred,they were divided into non-PPH group(n=340)and PPH group(n=36).Univariate analysis and logistic multivariate regression model were used to screen the independent risk factors of PPH in women with GDM who underwent vaginal trial failure and coversion to cesarean section.Results There were significant differences in the incidence of PPH in GDM women with different ages,pre-pregnancy body mass index(BMI),hemoglobin A1c(HbA1c),cicatritic uterus,gestational hypertension,prenatal fibrinogen level,placental adhesion,gynecological inflammation,labor analgesia,macrogynia,and incision tear(χ^(2)=4.99,8.29,65.46,12.32,9.71,7.05,6.51,4.73,9.71,9.79,P<0.05),The degree of preoperative uterine dilation and trial labor duration in PPH group were higher than those in non-PPH group,with statistical significance(t=2.09,3.70,P<0.05).Logistic regression analysis showed that BMI>28 kg/m~2 before pregnancy,HbA1c≥7%,scarred uterus,prenatal fibrinogen ≤3 g/L,long trial labor time,macrogynia and uterine incision tear were independent risk factors for PPH after vaginal trial failure and cesarean section in GDM women(OR=1.68,5.98,2.55,3.82,4.57,3.10,2.32,P<0.05).Conclusion The occurrence of PPH in cesarean section in women with vaginal trial failure in GDM is related to high BMI before pregnancy,low fibrinogen,high HbA1c,long trial labor time,scarred uterus,macrogynia and incision tear.

关 键 词：妊娠糖尿病 中转剖宫产 产后出血 危险因素 

分 类 号：R71[医药卫生—妇产科学]