目的:探讨低置胎盘产妇阴道分娩产后出血的高危因素.方法:分析上海市第一妇婴保健院2014年1月至2015年12月阴道分娩的345例低置胎盘活产单胎患者临床资料,按产后出血与否分为两组行单因素分析,并使用多因素Logistic回归分析评估各项高危因素.结果:产后出血共47例,总产后出血率13.6％.单因素分析显示辅助生殖受孕、产前出血史、胎盘距宫颈内口距离、胎盘粘连与产后出血有关(P＜0.05),Logistic多因素回归分析中则表明辅助生殖受孕(OR=8.181,95％ CI 3.072 ～21.791)及胎盘粘连(OR =6.543,95％ CI 3.107 ～ 13.775)为低置胎盘产后出血的独立高危因素.结论:低置胎盘患者应进行系统产前检查和分娩前经阴道超声检查,对各种高危因素进行分析评估,可能能提供更好的低置胎盘患者分娩方式的选择及对产后出血风险的预测,从而降低其产后出血率.%Objective:To analyse the risk factors of postpartum hemorrhage in vaginal delivery patients with low-lying placenta.Methods:We retrospectively evaluated the data from January 2014 to December 2015 of 345 cases of vaginal delivery pregnant women with low-lying placenta.According to postpartum hemorrhage,the data were divided into two groups:single factor analysis and multivariate logister regression analysis were used to assess the risk factors.Results:Postpartum hemorrhage in 47 cases,the total rate is 13.6％.Univariate analysis showed that assisted reproductive conception,history of prenatal hemorrhage,placenta from the cervix within the distance ≤ 10 mm,placental adhesions were more prone to postpartum hemorrhage(P ＜ 0.05).Logistic multivariate regression analysis showed that assisted reproductive conception (OR =8.181,95％ CI 3.072-21.791) and placental adhesions(OR=6.543,95％ CI 3.107-13.775) were independent risk factors for postpartum hemorrhage.Conclusions:Systematic prenatal care,carefully transvaginal ultrasound examination before labor and evaluation of these risk factors,may be able to provide a better choice of mode of delivery to low-lying placenta patients and predict postpartum hemorrhage risk,thereby reducing its postpartum hemorrhage rate.
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