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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

蒋芳,  高劲松,  周希亚,  刘俊涛,  杨剑秋,  边旭明

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文章导航 > 协和医学杂志  > 2012 >  3(1): 109-112
蒋芳, 高劲松, 周希亚, 刘俊涛, 杨剑秋, 边旭明. 不同分娩方式对产后出血低危孕妇出血量的影响[J]. 协和医学杂志, 2012, 3(1): 109-112. doi: 10.3969/j.issn.1674-9081.2012.01.022
引用本文: 蒋芳, 高劲松, 周希亚, 刘俊涛, 杨剑秋, 边旭明. 不同分娩方式对产后出血低危孕妇出血量的影响[J]. 协和医学杂志, 2012, 3(1): 109-112. doi: 10.3969/j.issn.1674-9081.2012.01.022
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Fang JIANG, Jin-song GAO, Xi-ya ZHOU, Jun-tao LIU, Jian-qiu YANG, Xu-ming BIAN. Influence of Different Delivery Modes on Postpartum Hemorrhage in Low-risk Women[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(1): 109-112. doi: 10.3969/j.issn.1674-9081.2012.01.022
Citation: Fang JIANG, Jin-song GAO, Xi-ya ZHOU, Jun-tao LIU, Jian-qiu YANG, Xu-ming BIAN. Influence of Different Delivery Modes on Postpartum Hemorrhage in Low-risk Women[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(1): 109-112. doi: 10.3969/j.issn.1674-9081.2012.01.022
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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

doi: 10.3969/j.issn.1674-9081.2012.01.022

  • 中国医学科学院 北京协和医学院 北京协和医院妇产科, 北京 100730

详细信息
    通讯作者:

    高劲松 电话:010-65296219, E-mail:gaojsong@sohu.com

  • 中图分类号: R714;

Influence of Different Delivery Modes on Postpartum Hemorrhage in Low-risk Women

  • Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   目的  比较不同分娩方式对产后出血低危孕妇出血量的影响。  方法  对2008年11月1日至2009年10月31日在北京协和医院正规产检足月单胎妊娠分娩产妇进行回顾性分析, 排除产后出血高危人群(包括前置胎盘、胎盘早剥、重度子痫前期)。所有入选产妇均于分娩前及产后48 h测定血常规, 比较剖宫产组与阴道分娩组血红蛋白(hemoglobin, HGB)和红细胞压积(hematocrit, 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下降中位数是-3 g/L(-10, -3 g/L), HCT下降中位数是-1%(-3.1%, -1.1%); 阴道分娩组HGB下降中位数是-8 g/L(-17, 0 g/L), HCT下降中位数是-2.8%(-5.4%, -0.1%)。剖宫产组HGB和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HGB下降中位数是-2.0 g/L(-12.7, 4 g/L), HCT下降中位数是-1.0%(-3.98%, 1.4%), 与择期剖宫产组比较差异无统计学意义(P=0.961, 0.691)。(3)吸引器助产、会阴侧切、产后刮宫是阴道分娩组产后出血量多的危险因素。  结论  产后出血低危孕妇, 阴道分娩出血量多于剖宫产分娩; 导致阴道分娩出血量增加的高危因素包括吸引器助产、会阴侧切和产后刮宫。
    Abstract:   Objective  To compare the blood loss between vaginal delivery and cesarean section in women at low-risk for postpartum hemorrhage, and to explore the risk factors of postpartum hemorrhage.  Method  The clinical data of nulliparous women who delivered in Peking Union Medical College Hospital from November 2008 to October 2009 were retrospectively analyzed. Women at high risk for postpartum hemorrhage (including placenta previa, placental abruption, and severe preeclampsia) were excluded. Pre-and post-delivery hematocrit (HCT) and hemoglobin (HGB) were recorded and compared between the vaginal delivery group and cesarean section group. The risk factors associated with postpartum hemorrhage were analyzed.  Result  After the delivery, the median decrease of HGB and HCT was-3 g/L (-10 g/L--3 g/L) and-1% (-3.1%--1.1%), respectively, in the elective cesarean section group, and was-8 g/L (-17 g/L-0 g/L) and-2.8% (-5.4%-0.1%) in the vaginal delivery group (both P < 0.05). The median decrease of HGB and HCT was-2.0 g/L (-12.7 g/L -4 g/L) and-1.0% (-3.98% -1.4%) in the no-episiotomy vaginal delivery group, which was not significantly different from that in the cesarean section group. Forceps, episiotomy, and postpartum curettage were risk factors for postpartum hemorrhage in vaginal delivery group.  Conclusions  For pregnant women at low risk for postpartum hemorrhage, blood loss during Cesarean section is larger than in vaginal delivery. Forceps, episiotomy, and postpartum curettage are risk factors for postpartum hemorrhage in vaginal delivery group.
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  • 表  1  剖宫产与阴道分娩组一般情况

    表  2  剖宫产与阴道分娩组出血量比较

    表  3  影响阴道分娩产后HGB和HCT下降值的相关因素
    • 参考文献(12)
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    [3] Stafford I, Dildy GA, Clark SL, et al. Visually estimated and calculated blood loss in vaginal and cesarean delivery[J]. Am J Obstet Gynecol, 2008, 199:519. e1-e7. http://www.onacademic.com/detail/journal_1000038953160710_5658.html
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    [7] Myers-Helfgott MG, Helfgott AW. Routine use of episiotomy in modern obstetrics:should it be performed?[J]. Obstet Gynecol Clin North Am, 1999, 26:305-325. doi:  10.1016/S0889-8545(05)70077-2
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    [10] Sosa CG, Althabe F, Belizan JM, et al. Risk factor for postpartum hemorrhage in vaginal deliveries in a latin-american population[J]. Ovstet Gynecol, 2009, 113:1313-1319. doi:  10.1097/AOG.0b013e3181a66b05
    [11] Magann EF, Lanneau GS. Third stage of labor[J]. Obstet Gynecol Clin North Am, 2005, 32:323-332. doi:  10.1016/j.ogc.2005.01.006
    [12] Lumbiganon P, Laopaiboon M, Gülmezoglu AM, et al. World Health Organization Global Survey on Maternal and Perinatal Health Research Group. Method of delivery and pregnancy outcomes in Asia:the WHO global survey on maternal and perinatal health 2007-08[J]. Lancet, 2010, 375:490-499. doi:  10.1016/S0140-6736(09)61870-5
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出版历程
  • 收稿日期:  2011-05-26
  • 刊出日期:  2012-01-30

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