目的 探讨产后出血的临床因素和防治措施.方法 收集北京市房山区妇幼保健院2010年1月至2011年12月的74例产后出血病例进行回顾性分析.结果 住院分娩总数3 675例,产后出血74例,产后出血发生率2.01%.发生原因以子宫收缩乏力为主,共43例,占58.11%.74例产后出血中合并有高危因素61例,占82.43%,主要有:多次妊娠史28例(37.84%)、妊娠期高血压疾病5例(6.76%)、前置胎盘3例(4.05%)、胎盘早剥5例(6.76%)、双胎妊娠4例(5.41%)、羊水过多2例(2.70%)、巨大胎儿7例(9.46%)、瘢痕子宫6例(8.11%)、合并子宫肌瘤1例(1.35%)等.剖宫产分娩者比阴道分娩者产后出血的发生率明显增高(2.40% vs 1.05%),两者相比差异有统计学意义(χ2=6.86,P<0.01).结论 正确处理第三产程,加强产后2h观察.严格控制剖宫产率,避免无指征剖宫产术,做好产前宣教是降低产后出血发生的关键措施.%Objective To investigate the clinical factors of postpartum hemorrhage and its prevention measures. Methods The data of 74 cases of postpartum hemorrhage collected in Fangshan District Maternal and Child Health Hospital from January 2010 to December 2011 was retrospectively analyzed. Results The incidence of postpartum hemorrhage was 2. 01% ( 74/3 675 ), and it was mainly caused by uterine atony, which happened in 43 cases ( 58. 11% ). Sixty-one of 74 cases of postpartum hemorrhage were complicated with high-risk factors, accounting for 82. 43% , which mainly included 28 cases of multiple pregnancy history ( 37. 84% ), 5 cases of hypertension disorder complicating pregnancy ( 6.76% ), 3 cases of placenta praevia ( 4.05% ), 5 cases of placental abruption ( 6. 76% ), 4 cases of twin pregnancy ( 5. 41% ), 2 cases of polyhydramnios ( 2. 70% ), 7 cases of fetal macrosomia ( 9. 46% ), 6 cases of uterine scar ( 8. 11% ) and 1 case complicating uterus myoma ( 1. 35% ). Compared with that in vaginal delivery, the incidence of postpartum hemorrhage in cesarean delivery was significantly increased ( 2. 40% vs 1. 05% ), and the difference was statistically significant (χ2 = 6. 86, P<0.01 ). Conclusion Correct processing the third stage of labor, strengthening observation on the period of two hours after delivery, strictly controlling the rate of cesarean section, avoiding cesarean section without indications and doing prenatal education are the key measures to reduce the incidence of postpartum hemorrhage.
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