283例中央性前置胎盘产后出血高危因素分析-东南大学学报医学版

283例中央性前置胎盘产后出血高危因素分析

单位：1. 北京海淀妇幼保健院产科, 北京 100080;
2. 北京大学公共卫生学院劳动卫生与环境卫生学系, 北京 100191;
3. 包头医学院公共卫生学院劳动卫生与环境卫生学系, 内蒙古包头 014040

分类号：R714.25

出版年·卷·期（页码）：2015·34·第六期（908-913）

摘要：

目的:观察中央性前置胎盘的临床表现及结局,探讨其产后出血的高危因素.方法:回顾性分析我院2006年9月至2015年6月283例中央性前置胎盘患者的临床资料,根据是否并发产后出血而分为2组.结果:产后出血组114例,产后未出血组169例;产后出血组的产前出血率、人工流产史发生率以及并发胎盘粘连、胎盘植入率均显著高于产后未出血组(P<0.05);Logistic回归分析表明,双胎(OR=10.94,95%CI: 1.120~106.871)、妊娠期合并胎盘粘连(OR=4.11, 95%CI: 0.946~17.852)、产前出血(OR=2.60,95%CI: 1.328~5.089)、产检次数(OR=1.13,95%CI: 1.026~1.243)以及并发贫血(OR=2.37,95%CI: 1.078~5.206)均是孕产妇发生产后出血的高危险因素,而高龄初产(OR=0.35,95%CI:0.117~1.057)、妊娠期合并瘢痕子宫(OR=0.285,95%CI: 0.057~1.441)为中央性前置胎盘并发产后出血的保护因素.结论:中央性前置胎盘常并发多种不良妊娠结局;双胎、妊娠期合并胎盘粘连、产前出血、并发贫血等可能为其并发产后出血的高危因素,高龄初产、妊娠期合并瘢痕子宫可能是中央性前置胎盘并发产后出血的保护因素.

Objective: To observe the clinical manifestation and outcome of central placenta previa and further explore the risk factors of postpartum hemorrhage with central placenta previa. Methods: 283 patients with central placenta previa in our hospital between September,2006 to June,2015 were retrospectively analyzed. According to the circumstance of postpartum hemorrhage, they were divided into two groups, postpartum hemorrhage group and no postpartum hemorrhage.Results: There were 114 cases in postpartum hemorrhage group and 169 cases in no postpartum hemorrhage group. Compared with no postpartum hemorrhage group, the rate of antepartum haemorrhage, abortion, placenta conglutination and placenta implantation were significantly higher in postpartum hemorrhage group (P< 0.05). Logistic regression analysis showed that the twins (OR=10.94, 95% CI: 1.120-106.871), placenta adhesion (OR=4.11, 95% CI: 0.946-17.852), antepartum haemorrhage (OR=2.60, 95% CI: 1.328-5.089), the frequency of antenatal examination (OR=1.13, 95% CI: 1.026-1.243),and anemia (OR=2.37, 95% CI: 1.078-5.206) were the high risk factors of postpartum hemorrhage with central placenta previa. Elder primipara (OR=0.35, 95% CI: 0.117-1.057) and scar uterus (OR=0.285, 95% CI: 0.057-1.441) were the protective factors of postpartum hemorrhage with central placenta previa.Conclusion: Central placenta previa is complicated by a variety of adverse pregnancy outcome.Twins,placenta adhesion, antepartum haemorrhage, and anemia may be the high risk factors of postpartum hemorrhage with central placenta previa.Elder primipara and scar uterus may be the protective factors of postpartum hemorrhage with central placenta previa.

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