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目的:观察研究产后出血的危险因素,并探讨救治策略。方法:研究对象为从2012年1月到2013年12月期间住院分娩的1648例产妇。24h之内阴道分娩出血量超过500ml,剖宫产出血量超过1000ml视为产后出血。观察内容包括产妇的年龄,胎数,胎产次,分娩方式,妊娠合并症及并发症,胎盘情况,子宫情况以及其它生理指标等。结果:共45例符合出血标准,发生率2.73%。未出现死亡病例。采用单因素分析,筛选出9个相关因素,包括年龄、胎数、产次、产道损伤、前置胎盘、胎盘粘连植入残留、分娩方式、血功能障碍异常、子宫收缩乏力。采用多因素Logistic回归分析,对以上的产后出血相关因素进行分析,筛选得出子宫收缩乏力、前置胎盘、胎盘粘连植入残留和产道损伤是产后出血的高危因素。结论:本研究发现出子宫收缩乏力、前置胎盘、胎盘粘连植入残留和产道损伤是产后出血的最重要、最直接的危险因素。加强孕妇的产前教育,及时筛查识别危险因素,并做好相关的综合预防措施,及时发现、干预、处理,能够有效降低产后出血的发生率,从而降低孕产妇的死亡率。
Objective: To observe and study the risk factors of postpartum hemorrhage and to explore the treatment strategy. METHODS: The study population consisted of 1648 mothers hospitalized for childbirth between January 2012 and December 2013. Vaginal bleeding within 24h more than 500ml, cesarean section more than 1000ml of bleeding as postpartum hemorrhage. Observations include maternal age, number of births, births, mode of delivery, complications and complications of pregnancy, placenta, uterine conditions and other physiological indicators. Results: A total of 45 cases met the bleeding standard, the incidence of 2.73%. No deaths occurred. Nine factors related to age, number of fetuses, parity, birth canal injury, placenta previa, residual placenta accreta implanted, mode of delivery, abnormal blood dysfunction, and uterine atony were selected by univariate analysis. Multivariate Logistic regression analysis was used to analyze the above factors related to postpartum hemorrhage. We found that uterine atony, placenta previa, placenta accreta and left ventricular injury were the risk factors of postpartum hemorrhage. Conclusion: The study found that uterine atony, placenta previa, placenta accreta and the birth canal injury is the most important postpartum hemorrhage, the most direct risk factors. Strengthen prenatal education of pregnant women, timely screening to identify risk factors, and make a comprehensive integrated preventive measures, timely detection, intervention, treatment, can effectively reduce the incidence of postpartum hemorrhage, thereby reducing maternal mortality.