孕晚期部分凝血及纤溶指标的检测对低危产妇产后出血的预测价值

摘要

目的 探讨孕晚期凝血及纤溶相关指标的检测对低危产妇产后出血的预测价值.方法 共计2 562例无其他合并症的单胎初产妇入组,在孕32～ 33周抽取外周血测定血小板(PLT)计数、血红蛋白(Hb)、血浆纤维蛋白原(Fbg)及D-二聚体(D-D)浓度,定期随访至分娩,共有48例发生产后出血,其中有16例严重产后出血.结果 严重出血组的Fbg浓度[(4.3±1.2)g/L]低于正常产妇组[(4.8±0.8)g/L](P =0.007).将入组者分为2组时,产后出血组血浆D-D含量[(1.8±1.3)g/L]高于正常产妇组[(1.3±0.9)g/L](P=0.001).当分为3组时,严重产后出血组血浆D-D含量[(2.4±1.7)g/L]高于普通产后出血组[(1.5±0.8)g/L]和正常产妇组[(1.3±0.9)g/L](P=0.000).严重出血组PLT计数[(172.4±38.9) ×109]低于正常产妇组[197.8±50.9)×109],(P =0.044).孕晚期测定血浆中Fbg的含量对产后出血有一定的预测作用(OR=1.89,95％ CI:1.68～2.03)；孕晚期D-D的测定对产后出血有预测价值(OR=2.09,95％CI:1.78～ 2.30).孕晚期血浆中PLT计数下降,对严重产后出血的预测价值不明确(OR=1.50,95％ CI:0.68 ～ 1.93).结论 孕晚期测定D-D及Fbg浓度对产后出血有一定的预测价值.%Objective To investigate the significance of coagulation and fibrinolysis related parameters in the third trimester for predicting the postpartum hemorrhage among low-risk pregnant women.Methods A total of 2 562 singleton uncomplicated primiparous women were enrolled,and their peripheral blood was taken during 32-33 gestational weeks.The platelet (PLT) count,hemoglobin (Hb),fibrinogen (Fbg) and D-dimer (D-D) levels were determined.These women were followed up till delivery.The 48 of 2 562 women developed postpartum hemorrhage,including 16 of 48 women had severe postpartum hemorrhage.Results The Fbg level in severe postpartum hemorrhage group[(4.3 ±1.2) g/L] was lower than that in the normal pregnant group [(4.8 ± 0.8) g/L,P =0.007].When the participants were divided into 2 groups (normal pregnant group and postpartum hemorrhage group),the postpartum hemorrhage group had higher D-D level than the normal pregnant group [(1.8 ± 1.3) g/L and (1.3 ± 0.9) g/L,P =0.001].When the participants were divided into 3 groups (normal pregnant group,postpartum hemorrhage group and severe postpartum hemorrhage group),the D-D level in the severe postpartum hemorrhage group was the highest with statistical significance [(2.4 ±1.7)g/L and (1.5 ±0.8)g/L,P=0.000];[(2.4 ±1.7)g/L and (1.3 ±0.9)g/L,P =0.000].The PLT count in severe postpartum hemorrhage group was less than that in normal pregnant group [(172.4 ± 38.9) × 109 and (197.8 ±50.9) × 109,P =0.044).The Fbg level determined in the third trimester had significance to predict postpartum hemorrhage among low-risk pregnant women [odd ratio(OR) =1.89,95％ confidence interval (CI):1.68-2.03].The D-D level had the prediction significance(OR =2.09,95％ CI:1.78-2.30).The decreasing PLT count in the third trimester had no obvious prediction significance (OR =1.50,95％ CI:0.68-1.93).Conclusions The D-D and Fbg levels in the third trimester could predict postpartum hemorrhage.