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目的:分析剖宫产产后出血的产前高危因素,为预防产后出血提供依据。方法:将暨南大学附属第一医院2002年1月～2008年12月间住院行剖宫产术终止妊娠发生产后出血的产妇100例作为病例组,选择同期非出血剖宫产产妇100例作为对照组。采用回顾性病例对照研究设计方法,对比两组产后出血相关危险因素的暴露率及结局。结果:高龄、孕次≥3次、经产妇、流产≥2次、文化程度低、妊娠期高血压疾病、中重度贫血、红细胞<3.50×109/L、妊娠合并子宫肌瘤(≥3cm)、前置胎盘、血小板<100×109/L、胎盘早剥、宫缩抑制剂的使用、多胎均为产后出血的高危因素。经多因素Logistic回归分析,产前应用宫缩抑制剂、经产妇、妊娠合并子宫肌瘤(≥3 cm)、前置胎盘、双胎和文化程度低是剖宫产产后出血的独立高危因素。结论:产前使用宫缩抑制剂者应加强产后出血的防治,妊娠合并子宫肌瘤直径≥3 cm者,不建议在剖宫产术中常规实施子宫肌瘤剔除术。
Objective: To analyze the risk factors of prenatal bleeding after cesarean section and provide basis for prevention of postpartum hemorrhage. Methods: 100 cases of postpartum hemorrhage with cesarean delivery in the First Affiliated Hospital of Jinan University from January 2002 to December 2008 were selected as the case group, and 100 cases of non-bleeding cesarean section during the same period were selected as controls group. A retrospective case-control study design method was used to compare the exposure rates and outcomes of the two risk factors associated with postpartum hemorrhage. Results: The elderly, pregnancy times ≥ 3 times, the maternal, miscarriage ≥ 2 times, low education, hypertensive disorders of pregnancy, moderate to severe anemia, erythrocytes <3.50 × 109 / L, pregnancy with uterine fibroids (≥ 3cm) Placenta previa, platelets <100 × 109 / L, placental abruption, the use of tocolytic agents, multiple births are risk factors for postpartum hemorrhage. Multivariate Logistic regression analysis showed that prenatal tocolytic agents, maternal, pregnant women with uterine fibroids (≥3 cm), placenta previa, twins and low education level were the independent risk factors for postpartum hemorrhage after cesarean section. Conclusion: Prenatal tocolytic agents should be strengthened prevention and treatment of postpartum hemorrhage, pregnancy with uterine fibroids ≥ 3 cm in diameter, cesarean section is not recommended for routine implementation of myomectomy.