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目的探讨晚期产后出血(LPH)的高危因素、病因及其临床特征,为提高其临床诊治水平提供参考。方法收集广州医科大学附属第三医院100例LPH患者作为研究对象,并对其一般资料、晚期产后出血率及高危因素、出血原因、临床特征、症状、出血量进行回顾性分析。结果分娩共50 010例,产后出血孕妇768例(1.53%),LPH 100例(0.20%),其中阴道分娩LPH发生率0.13%,剖宫产LPH发生率0.28%;剖宫产分娩孕妇LPH发病率明显高于阴道分娩,且阴道分娩产妇出血量(518.3±31.9)mL明显低于剖宫产组(769.3±13.7)mL,差异有统计学意义(P<0.05);阴道分娩组LPH主要由胎盘胎膜残留所致,而剖宫产组主要是由切口愈合不良所致;剖宫分娩组突发性出血率、持续性出血率及子宫压痛率均明显高于阴道分娩组,差异有统计学意义(P<0.05)。结论筛查高危妊娠,做好产程管理;产后密切注意产妇身体情况,鼓励阴道分娩等可降低LPH发生率。
Objective To investigate the risk factors, etiology and clinical features of late postpartum hemorrhage (LPH) and provide references for improving their clinical diagnosis and treatment. Methods A total of 100 cases of LPH in the Third Affiliated Hospital of Guangzhou Medical University were collected and analyzed retrospectively. The general data, late postpartum hemorrhage rate, high risk factors, bleeding causes, clinical features, symptoms and bleeding volume were retrospectively analyzed. Results A total of 50 010 cases of childbirth, postpartum hemorrhage 768 cases of pregnant women (1.53%), 100 cases of LPH (0.20%), of which 0.13% incidence of LPH vaginal delivery, caesarean section incidence of LPH 0.28%; cesarean section delivery pregnant women LPH (518.3 ± 31.9) mL in vaginal delivery were significantly lower than those in cesarean section (769.3 ± 13.7) mL, the difference was statistically significant (P <0.05). The incidence of LPH in vaginal delivery was Placental membranes caused by residual, while the cesarean section was mainly caused by incision poor healing; cesarean section delivery group of sudden bleeding rate, persistent hemorrhage rate and uterine pressure were significantly higher than the vaginal delivery group, the difference was statistically Significance (P <0.05). Conclusions Screening for high-risk pregnancies does a good job of labor management; pay close attention to maternal physical condition after birth and encourage vaginal delivery can reduce the incidence of LPH.