28例产后出血影响因素探讨
28例产后出血影响因素探讨 【摘要】 目的 分析产后出血的原因、相关因素,探讨降低产后出血的发生率,提出合理的防治措施。方法 对产后出血28例资料进行分析,并进行统计学检验。结果 子宫收缩乏力仍为产后出血的首位原因,占 。发生产后出血的病例,在孕期存在不同程度的高危因素。有流产史、经产妇产后出血发生率高于无流产史者和初产妇,;分娩方式中,阴道手术助产产后出血发生率高于剖宫产和阴道分娩者,;多胎妊娠产后出血发生率高于单胎妊娠,;新生儿体重≥4000g者产后出血的发生率高于新生儿体重4000g者,;无早接触、早吸吮者产后出血发生率高于有早接触、早吸吮者,。结论 加强孕期健康教育及孕期管理,严格掌握剖宫产指征,提高医务人员助产技术,同时提倡早接触、早吸吮,对降低产后出血发生率起着重要作用。 【关键词】 产后出血;相关因素;干预措施 【Abstract】 Objective To analyze the reason of postpartum hemorrhage and understand the related factors to explore how to reduce the incidence of postpartum hemorrhage and propose reasonable prevention and control Analyzing 28 cases of postpartum hemorrhage and taking a statistical test. Results The most important cause was that the uterus was weak, accounting for . As for all the cases, there were various risky factors during pregnancy. The number of those who had the history of abortion or those who had already born a child was higher than those without the history of abortion or those who bear the first child, The number of those with multiple pregnancy was higher than those with a single child, The number of those whose babies’ birth weight was over 4000g was higher than those whose babies’ birth weight was below 4000g, The number of those without early contact between the mother and the baby and early sucking was higher than those with early contact and early sucking, Conclusion There are many measures to reduce the incidence of postpartum hemorrhage, including strengthening the health education and management during pregnancy, strictly grasping Cs cesarean section standard, improving the ability of midwife and promoting early contact, as well as early sucking. These measures play a very important role in reducing the incidence. 【Key words】 postpartum hemorrhage; related factors; intervention measure 产后出血是产科常见的严重并发症,无论是世界卫生组织报告资料,还是全国孕产妇死亡监测结果,均显示产后出血是孕产妇死亡的首位原因[1],因此,降低孕产妇出血的发生率,仍为产科面临的重要课题。对我院28例产科出血的病例进行分析,以阐述产后出血的相关因素,制定干预措施,降低孕产妇死亡率。 1 资料与方法 1.1 一般资料 资料来源于2005年1月2007年12月31日在我院分娩产妇1440例,发生产后出血28例的有关资料。 1.2 方法 产后出血的诊断标准胎儿娩出后24h内失血量超过500ml者为产后出血。出血量的测量方法阴道分娩。胎儿娩出后,立即将接血弯盘放于产妇臀下至产后2h取出,直接测量弯盘内的血量,以称重估计血染的纱布及血染产单上的血量,回病房后至产后24h以会阴垫集血,亦以称重法计算出血量,上述出血量的总和为产后24h的出血量。剖宫产分娩。子宫壁切开后先吸尽羊水弃之,然后负压瓶积血,余出血量方法与阴道分娩相同。 2 结果 2.1 基本情况 2005年1月2007年12月31日分娩人数1440例,产后出血28例,产后出血发生率。其中年龄最小为18岁,最大40岁。初产妇12例,经产妇16例。剖宫产13例,阴道助产6例,顺产9例。孕周31~425周,最多出血量为3300ml,发生失血性休克2例,其中1例为胎盘大部分植入行子宫全切除。未发生因产后出血而引起孕产妇死亡。 2.2 产后出血原因 宫缩乏力18例,其中巨大儿6例,妊娠期高血压1例,产程延长4例,双胎妊娠2例,羊水过多2例,子宫肌瘤1例,胎盘早剥1例,其他因素1例; 胎盘因素6例,差异有显着性。 .3 分娩史 1440例产妇中初产妇790例,发生产后出血10例,发生率;经产妇为650例,发生产后出血18例,发生率,差异有显着性。 .4 分娩方式 28例病例中,顺产9例,同期顺产总数680例,产后出血率;剖宫产13例,同期剖宫产总例数678例,产后出血发生率;阴道助产手术6例,同期阴道助产手术82例,产后出血发生率,差异有显着性。 胎次与胎儿体重 1440例分娩中,多胎妊娠22例,发生产后出血2例,发生率;同期单胎分娩总数1418例,发生产后出血26例,发生率,差异有显着性。同期分娩人次中,新生儿体重≥4000g者102例,发生产后出血5例,发生率;新生儿体重4000g者为1338例,发生产后出血23例,发生率,差异有显着性。 早接触及早吸吮 1440例中有早接触、早吸吮者1260例,发生产后出血15例,发生率,无早接触、早吸吮180例,发生产后出血13例,发生率,差异有显着性。3 讨论 本资料中,产后出血是我国孕产妇死亡的首位原因,而子宫收缩乏力是导致产后出血的主要原因,而子宫收缩乏力的