协和医学杂志

2012, (01)

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不同分娩方式对产后出血低危孕妇出血量的影响
Analysis of the impact of postpartum hemorrhage in vaginal delivery and cesarean section

蒋芳;高劲松

摘要(Abstract):

目的: 对产后出血低危孕妇,比较不同分娩方式的产后出血量及影响因素。方法: 对2008年11月1日到2009年10月31日间在我院正规产检的足月单胎妊娠分娩的产妇进行回顾性分析,排除产后出血的高危人群(包括前置胎盘、胎盘早剥、重度子痫前期)。所有产妇均于分娩前和产后48小时测定血常规,比较两组产妇血红蛋白(Hgb)和红细胞压积(Hct)的变化值,分析影响产后出血量的因素。结果: 1、择期剖宫产组产后Hgb下降的中位数是-3 g/l(-10, 3)g/l,Hct下降的中位数是-1%(-3.1, 1.1)%,阴道分娩组Hgb下降的中位数是-8 g/l(-17, 0)g/l,Hct下降的中位数是-2.8%(-5.4, -0.1)%。剖宫产组Hgb、Hct差值明显小于阴道分娩组(P=0.000)。2、阴道分娩组中未行侧切组的Hgb下降的中位数是-2.0 g/l (-13,4),Hct下降的中位数是-1.0%(-3.9,1.4),与择期剖宫产组相比没有显著性差异(P=0.961,0.691)。3、阴道分娩组中,吸引器助产、会阴侧切、产后刮宫是产后出血量多的危险因素。结论:对产后出血低危孕妇,阴道分娩的出血量多于剖宫产分娩。导致阴道分娩出血增加的高危因素包括吸引器助产、会阴侧切和产后刮宫。
Objective: To compare blood lose between vaginal delivery and cesarean section in women at low-risk for postpartum hemorrhage , and to find risk factor of postpartum hemorrhage. Method: Clinical data of nulliparous women delivered in Peking Union Medical College Hospital during November 2008 to December 2009 were analyzed retrospectively. Exclude women at high risk for postpartum hemorrhage(Placenta previa、Placental abruption、Severe preeclampsia). Pre- and postdelivery hematocrit(Hct) and hemoglobin(Hgb) were recorded, the changes of Hgb and Hct were compared in two groups, and analysis the risk factor associated with postpartum hemorrhage。 Result: 1、The median value of the decrease of Hgb in cesarean section group and vaginal delivery group was-3 g/l(-10, 3)g/l and -8 g/l(-17, 0)g/l respectively, The median value of the decrease of Hct in cesarean section group and vaginal delivery group was-1%(-3.1, 1.1)% and -2.8%(-5.4, -0.1)% respectively. The decrease of Hgb and Hct was significantly lower in cesarean section group than in vaginal delivery group. 2.The median value of the decrease of Hgb and Hct in no episiotomy vaginal delivery group was-2.0 g/l (-13,4)g/l and -1.0%(-3.9,1.4)respectively, and has no significantly difference comparing with cesarean section group.3., Forceps、episiotomy and postpartum curettage are risk factor for postpartum hemorrhage in vaginal delivery group. Conclusion:1 For pregnant at low-risk for postpartum hemorrhage, blood loss during cesarean section was greater than in vaginal delivery. 2. Forceps、episiotomy and postpartum curettage are risk factor for postpartum hemorrhage in vaginal delivery group.

关键词(KeyWords): |产后出血|阴道分娩|会阴侧切|
|postpartum hemorrhage|vaginal delivery|episiotomy|

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作者(Author): 蒋芳;高劲松

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