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目的 了解南京市妇女剖宫产术后 2 4h内的失血量及出血情况。方法 对南京市城、郊、县的一、二、三级医院 ,按东、西、南、北、中的地理位置进行分层抽样调查 ,各调查单位按连续病案号的方法纳入观察对象。出血量测量方法为容积法 +称重法 +面积法。结果 抽样的 4 171例产妇中 ,112 5例为剖宫产分娩 ,其剖宫产指征依次为头盆不称、胎儿窘迫、臀位 ;剖宫产指征不明确者占10 4 %。剖宫产术产后出血量中位数为 5 2 0ml,明显高于阴道分娩者 (30 4 6例 )的 397ml(P <0 0 1)。若以出血量≥ 5 0 0ml为产后出血的诊断标准 ,则剖宫产术产后出血发生率高达 5 3 7% ,无出血高危因素的剖宫产者 ,第 80百分位数产后出血量为 6 78ml;若以出血量≥ 70 0ml为诊断标准 ,则剖宫产术产后出血发生率为 19 8%。结论 (1)剖宫产术本身就是产后出血的原因 ,为母亲健康 ,应努力降低剖宫产率 ;(2 )剖宫产术产后出血的诊断标准以出血量≥ 70 0ml为宜
Objective To understand the blood loss and bleeding in women within 24 hours after cesarean section in Nanjing. Methods Stratified sampling surveys were conducted at the first, second, and third-level hospitals in Nanjing City, Suburbs, and counties according to the geographic locations of the east, west, south, north, and China. All survey units were included in the observations according to the consecutive case numbers. The method of measuring blood loss was volume method + weighing method + area method. RESULTS Among the 4,171 maternity women sampled, 1,125 were delivered by cesarean section. The indications for cesarean section were cephalopelvic disproportion, fetal distress, and breech presentation. The cesarean section indication was unclear and accounted for 104%. The median postpartum hemorrhage volume for cesarean section was 520ml, which was significantly higher than the 397ml for vaginal delivery (306 cases) (P < 0.01). If the hemorrhage volume ≥ 500ml is the diagnostic criterion for postpartum hemorrhage, the incidence of postpartum hemorrhage in cesarean section is as high as 533%. The cesarean section with no risk factors for bleeding is the occupant of the 80th percentile. 6 78ml; If the amount of bleeding ≥ 70 0ml as the diagnostic criteria, the incidence of postpartum hemorrhage cesarean section rate of 198%. Conclusions (1) Caesarean section itself is the cause of postpartum hemorrhage. For the mother’s health, efforts should be made to reduce the cesarean section rate; (2) The diagnostic criteria for postpartum hemorrhage at cesarean section should be ≥ 70 ml.