Zhang H, Wu K Q, Luo P X, Zhu B
Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006,China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2023 Feb 6;57(2):215-221. doi: 10.3760/cma.j.cn112150-20220309-00219.
To analyze associated factors and adverse pregnancy outcomes of postpartum hemorrhage in the caesarean section of puerperae with different types of placenta previa. This retrospective research was a case-control study. Puerperae with cesarean section of placenta previa from January 2019 to December 2020 in Women's Hospital, School of Medicine, Zhejiang University were collected and divided into the<1 000 ml control group or ≥1 000 ml postpartum hemorrhage group according to the amount of blood loss during cesarean section. Differences in continuous variables were analyzed by -test and categorical variables were analyzed by test. The risk factors of postpartum hemorrhage were analyzed by logistic multivariate regression. A total of 962 puerperae were enrolled with 773 cases in the control group and 189 cases in the postpartum hemorrhage group. The incidence of gestational weeks, gravidity, parity, induced abortion, placental accreta and preoperative hemoglobin<110 g/L was significantly different between two groups in different types of placenta previa (<0.001). Logistic multivariate regression model analysis showed that the independent risk factors of postpartum hemorrhage in the caesarean section of low-lying placenta included placental accreta (=12.713, 95% 4.296-37.625), preoperative hemoglobin<110 g/L (=2.377, 95% 1.062-5.321), and prenatal vaginal bleeding (=4.244, 95% 1.865-9.656). The independent risk factors of postpartum hemorrhage in the caesarean section of placenta previa included once induced abortion (=2.789, 95%1.189-6.544), induced abortion≥2 (=2.843, 95%1.101-7.339), placental accreta (=6.079, 95%3.697-9.996), HBsAg positive (=3.891, 95%1.385-10.929), and placental attachment to the anterior uterine wall (=2.307, 95%1.285-4.142). The rate of postpartum hemorrhage and premature delivery in puerperae with placenta previa was higher than that in puerperae with low-lying placenta (<0.001). The associated factors of postpartum hemorrhage in puerperae with different types of placenta previa are different. Placenta accreta is the common risk factor of postpartum hemorrhage in puerperae with low-lying placenta and placenta previa.
分析不同类型前置胎盘产妇剖宫产产后出血的相关因素及不良妊娠结局。本回顾性研究为病例对照研究。收集2019年1月至2020年12月在浙江大学医学院附属妇产科医院行前置胎盘剖宫产的产妇，根据剖宫产术中失血量分为<1000ml对照组或≥1000ml产后出血组。连续变量差异采用t检验分析，分类变量采用χ²检验分析。采用logistic多因素回归分析产后出血的危险因素。共纳入962例产妇，对照组773例，产后出血组189例。不同类型前置胎盘两组间孕周、孕次、产次、人工流产史、胎盘植入和术前血红蛋白<110g/L的发生率差异有统计学意义（P<0.001）。logistic多因素回归模型分析显示，低置胎盘剖宫产产后出血的独立危险因素包括胎盘植入（β=12.713，95%CI 4.296-37.625）、术前血红蛋白<110g/L（β=2.377，95%CI 1.062-5.321）和产前阴道出血（β=4.244，95%CI 1.865-9.656）。前置胎盘剖宫产产后出血的独立危险因素包括人工流产1次（β=2.789，95%CI 1.189-6.544）、人工流产≥2次（β=2.843，95%CI 1.101-7.339）、胎盘植入（β=6.079，95%CI 3.697-9.996）、HBsAg阳性（β=3.891，95%CI 1.385-10.929）和胎盘附着于子宫前壁（β=2.307，95%CI 1.285-4.142）。前置胎盘产妇产后出血及早产发生率高于低置胎盘产妇（P<0.001）。不同类型前置胎盘产妇产后出血的相关因素不同。胎盘植入是低置胎盘和前置胎盘产妇产后出血的共同危险因素。
