再次剖宫产产后出血危险因素分析:2442例产妇的回顾性研究
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摘要
目的通过回顾性病例数据分析,探讨再次剖宫产产妇产后出血的相关危险因素。方法基于医院电子病历系统,搜集本院产科2015年10月至2017年10月再次剖宫产产妇的临床病历资料,记录产妇的基本信息、术前情况、妊娠相关并发症、麻醉、术中及术后情况等资料。应用Logistic回归模型分析筛选产后出血的危险因素。结果共纳入分析2 442例符合要求的再次剖宫产产妇,根据产后出血标准分为产后出血组(346例)和非产后出血组(2 096例)。Logistic回归分析显示,再次剖宫产产后出血的主要危险因素包括:前置胎盘(aOR=17. 858,95%CI=8. 359～38. 149)、产前贫血(aOR=10. 882,95%CI=6. 190～19. 129)、宫缩乏力(aOR=6. 608,95%CI=3. 604～12. 115)、手术时间> 100 min(aOR=5. 202,95%CI=2. 196～12. 321;参考组:手术时间≤60 min)等。结论前置胎盘是再次剖宫产产后出血的首要风险因素,其次,产前贫血、宫缩乏力、胎盘粘连、胎盘植入、手术时间过长也与产后出血密切相关。
Objective To investigate the risk factors of postpartum hemorrhage for repeat cesarean delivery by retrospective analysis. Methods Based on the electronic medical records of our hospital during October 2015 and October 2017,clinical data of the women with repeat cesarean delivery,including basic information,maternal characteristics,preoperative conditions,pregnancy-related complications,anesthesia,intra-and post-operative conditions were collected. Logistic regression analysis was performed to investigate the risk factors for postpartum hemorrhage. Results A total of 2 442 patients who met the inclusion and exclusion criteria were included in the analysis. According to the definition of postpartum hemorrhage,they were assigned into the postpartum hemorrhage group( n = 346) and the non-postpartum hemorrhage group( n = 2 096). Logistic regression analysis indicated that the major risk factors for postpartum hemorrhage were placenta previa( a OR = 17. 858; 95% CI = 8. 359 ～ 38. 149),predelivery anemia( a OR = 10. 882,95% CI =6. 190 ～ 19. 129),uterine atony( a OR = 6. 608,95% CI = 3. 604 ～ 12. 115),and operation time > 100 min( a OR = 5. 202,95% CI = 2. 196 ～ 12. 321; the operation time of the reference group was ≤60 min).Conclusion Placenta previa is the primary risk factors of postpartum hemorrhage for repeat cesarean delivery. In addition, predelivery anemia, uterine atony, placental adhesion, placenta accrete and prolongation of operation time are also closely associated with postpartum hemorrhage.
Objective To investigate the risk factors of postpartum hemorrhage for repeat cesarean delivery by retrospective analysis. Methods Based on the electronic medical records of our hospital during October 2015 and October 2017,clinical data of the women with repeat cesarean delivery,including basic information,maternal characteristics,preoperative conditions,pregnancy-related complications,anesthesia,intra-and post-operative conditions were collected. Logistic regression analysis was performed to investigate the risk factors for postpartum hemorrhage. Results A total of 2 442 patients who met the inclusion and exclusion criteria were included in the analysis. According to the definition of postpartum hemorrhage,they were assigned into the postpartum hemorrhage group( n = 346) and the non-postpartum hemorrhage group( n = 2 096). Logistic regression analysis indicated that the major risk factors for postpartum hemorrhage were placenta previa( a OR = 17. 858; 95% CI = 8. 359 ～ 38. 149),predelivery anemia( a OR = 10. 882,95% CI =6. 190 ～ 19. 129),uterine atony( a OR = 6. 608,95% CI = 3. 604 ～ 12. 115),and operation time > 100 min( a OR = 5. 202,95% CI = 2. 196 ～ 12. 321; the operation time of the reference group was ≤60 min).Conclusion Placenta previa is the primary risk factors of postpartum hemorrhage for repeat cesarean delivery. In addition, predelivery anemia, uterine atony, placental adhesion, placenta accrete and prolongation of operation time are also closely associated with postpartum hemorrhage.
引文
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[10] BERGHOLT T,STENDERUP J K,VEDSTED-JAKOBSEN A,et al. Intraoperative surgical complication during cesarean section:an observational study of the incidence and risk factors[J]. Acta Obstet Gynecol Scand,2003,82(3):251-256. DOI:10. 1034/j. 1600-0412. 2003. 00095. x.
[11] LAL A K,HIBBARD J U. Placenta previa:an outcomebased cohort study in a contemporary obstetric population[J]. Arch Gynecol Obstet,2015,292(2):299-305.DOI:10. 1007/s00404-015-3628-y.
[12] KRAMER M S,BERG C,ABENHAIM H,et al. Incidence,risk factors,and temporal trends in severe postpartum hemorrhage[J]. Am J Obstet Gynecol,2013,209(5):449-441. DOI:10. 1016/j. ajog. 2013. 07. 007.
[13] BUTWICK A J,WALSH E M,KUZNIEWICZ M,et al.Patterns and predictors of severe postpartum anemia after Cesarean section[J]. Transfusion,2017,57(1):36-44.DOI:10. 1111/trf. 13815.
[14]刘兴会,杨慧霞.重视产后出血诊治过程的管理及评审[J].中华围产医学杂志,2016,19(4):252-253. DOI:10. 3760/cma. j. issn. 1007-9408. 2016. 04. 004.LIU X H,YANG H X. Pay attention to the management and review of the diagnosis and treatment of postpartum hemorrhage[J]. Chin J Perinat Med,2016(4):252-253. DOI:10. 3760/cma. j. issn. 1007-9408. 2016. 04. 004.
[15] SUMIKURA H,NIWA H,SATO M,et al. Rethinking general anesthesia for cesarean section[J]. J Anesth,2016,30(2):268-273. DOI:10. 1007/s00540-015-2099-4.
[16] DEVROE S,VAN DE VELDE M,REX S. General anesthesia for caesarean section[J]. Curr Opin Anaesthesiol,2015,28(3):240-246. DOI:10. 1097/ACO. 0000000000000185.
[2] LIANG J,MU Y,LI X,et al. Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016:observational study of nearly seven million health facility births[J]. BMJ,2018,360:k817. DOI:10. 1136/bmj. k817.
[3] GROBMAN W A,BAILIT J L,RICE M M,et al. Frequency of and factors associated with severe maternal morbidity[J].Obstet Gynecol,2014,123(4):804-810. DOI:10. 1097/aog. 0000000000000173.
[4] KNIGHT M,CALLAGHAN W M,BERG C,et al. Trends in postpartum hemorrhage in high resource countries:a review and recommendations from the international postpartum hemorrhage collaborative group[J]. BMC Pregnancy Childb,2009,9:55. DOI:10. 1186/1471-2393-9-55.
[5] BUTWICK A J,RAMACHANDRAN B,HEGDE P,et al.Risk factors for severe postpartum hemorrhage after cesarean delivery:case-control studies[J]. Anesth Analg,2017,125(2):523-532. DOI:10. 1213/ANE. 0000000000001962.
[6] SAAD A,COSTANTINE M M. Obstetric hemorrhage:recent advances[J]. Clin Obstet Gynecol,2014,57(4):791-796. DOI:10. 1097/GRF. 0000000000000062.
[7] KOLS T,IAN P,SKJELDESTAD F E. Risks for peroperative excessive blood loss in cesarean delivery[J]. Acta Obstet Gynecol Scand,2010,89(5):658-663. DOI:10.3109/00016341003605727.
[8] AL-ZIRQI I,VANGEN S,FORSEN L,et al. Prevalence and risk factors of severe obstetric haemorrhage[J]. BJOG,2008,115(10):1265-1272. DOI:10. 1111/j. 1471-0528.2008. 01859. x.
[9]苏鹤,许峰,焦秋芬,等.浅谈剖宫产产后出血的治疗研究进展[J].中国医药指南,2016,14(28):23-25.DOI:10. 15912/j. cnki. gocm. 2016. 28. 017.SU H,XU F,JIAO Q F,et al. Progress in the treatment of postpartum hemorrhage after cesarean section[J]. Guide China Med,2016,14(28):23-25. DOI:10. 15912/j.cnki. gocm. 2016. 28. 017.
[10] BERGHOLT T,STENDERUP J K,VEDSTED-JAKOBSEN A,et al. Intraoperative surgical complication during cesarean section:an observational study of the incidence and risk factors[J]. Acta Obstet Gynecol Scand,2003,82(3):251-256. DOI:10. 1034/j. 1600-0412. 2003. 00095. x.
[11] LAL A K,HIBBARD J U. Placenta previa:an outcomebased cohort study in a contemporary obstetric population[J]. Arch Gynecol Obstet,2015,292(2):299-305.DOI:10. 1007/s00404-015-3628-y.
[12] KRAMER M S,BERG C,ABENHAIM H,et al. Incidence,risk factors,and temporal trends in severe postpartum hemorrhage[J]. Am J Obstet Gynecol,2013,209(5):449-441. DOI:10. 1016/j. ajog. 2013. 07. 007.
[13] BUTWICK A J,WALSH E M,KUZNIEWICZ M,et al.Patterns and predictors of severe postpartum anemia after Cesarean section[J]. Transfusion,2017,57(1):36-44.DOI:10. 1111/trf. 13815.
[14]刘兴会,杨慧霞.重视产后出血诊治过程的管理及评审[J].中华围产医学杂志,2016,19(4):252-253. DOI:10. 3760/cma. j. issn. 1007-9408. 2016. 04. 004.LIU X H,YANG H X. Pay attention to the management and review of the diagnosis and treatment of postpartum hemorrhage[J]. Chin J Perinat Med,2016(4):252-253. DOI:10. 3760/cma. j. issn. 1007-9408. 2016. 04. 004.
[15] SUMIKURA H,NIWA H,SATO M,et al. Rethinking general anesthesia for cesarean section[J]. J Anesth,2016,30(2):268-273. DOI:10. 1007/s00540-015-2099-4.
[16] DEVROE S,VAN DE VELDE M,REX S. General anesthesia for caesarean section[J]. Curr Opin Anaesthesiol,2015,28(3):240-246. DOI:10. 1097/ACO. 0000000000000185.