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目的:分析产后出血的高危因素,探讨产后出血的防治措施。方法:对2007年～2009年我院分娩5438例产妇中90例产后出血患者的临床资料进行回顾性分析。结果:剖宫产、妊娠并发症及有流产史者的产后出血发生率及产后出血量均高于无上述高危因素者,2者比较有显著差异。宫缩乏力为产后出血的主要原因,占49.44%,但出血量≥2000ml的病例中胎盘因素所占比例大于出血量<1000ml的病例,两者比较有统计学差异。90例产后出血中70例经常规方法即能有效止血,占77.8%。不同出血量之间处理方法比较,随着出血量的增加,特殊方法所占比例明显增加,各组间比较有统计学差异。结论:剖宫产、妊娠并发症及有流产史为产后出血的高危因素。出血原因中胎盘因素仍应引起高度重视。严格掌握剖宫产指征,降低剖宫产率是减少产后出血的有效措施;加强围产保健监测,对高危孕妇在分娩前制定预防及治疗产后出血的方案,做到有备无患是成功处理产后出血的关键;对于难治性产后出血,在综合治疗的同时,及时采用B-Lynch缝合、子宫动脉结扎、介入栓塞术等措施明显有效,如经保守治疗无效果断行子宫切除术则为挽救孕产妇生命的有效措施。
Objective: To analyze the risk factors of postpartum hemorrhage and to explore the prevention and treatment measures of postpartum hemorrhage. Methods: The clinical data of 90 postpartum hemorrhage patients from 5438 maternal births in our hospital from 2007 to 2009 were analyzed retrospectively. Results: The incidence of postpartum hemorrhage and postpartum hemorrhage in cesarean section, pregnancy complications and abortion history were higher than those without the above mentioned risk factors. There was a significant difference between the two groups. Uterine inertia is the main cause of postpartum hemorrhage, accounting for 49.44%, but the proportion of placenta in cases of bleeding ≥ 2000ml is greater than the case of bleeding <1000ml, there is a statistically significant difference between the two. 70 cases of 90 cases of postpartum hemorrhage by conventional methods that can effectively stop bleeding, accounting for 77.8%. Comparison of different methods of treatment between the amount of bleeding, with the increase of the amount of bleeding, the proportion of special methods increased significantly, compared between the groups were statistically significant. Conclusion: Cesarean section, pregnancy complications and history of abortion are risk factors for postpartum hemorrhage. Causes of placental bleeding should still cause great attention. Strict control of cesarean section indications and reduce the rate of cesarean section is effective measures to reduce postpartum hemorrhage; strengthen perinatal health monitoring, the development of high-risk pregnant women before delivery to prevent and treat postpartum hemorrhage program, be prepared for the successful management of postpartum hemorrhage Of the key; for intractable postpartum hemorrhage, in the comprehensive treatment at the same time, the timely use of B-Lynch suture, uterine artery ligation, interventional embolization and other measures significantly effective, such as conservative treatment ineffective line hysterectomy is to save pregnant women Effective measures of life.