Analysis Of Risk Factors For Different Blood Loss In 529 Patients With Postpartum Hemorrhage

Objective:Postpartum hemorrhage is a common serious complication of maternal postpartum and the leading cause of maternal mortality in China.Different amounts of postpartum blood loss in postpartum hemorrhage have significant influence on pregnancy outcome and prognosis,but there are few studies on related risk factors of different amounts of postpartum hemorrhage in China.The purpose of this study is to explore the influence and correlation of related risk factors of different amounts of postpartum hemorrhage.Methods:Retrospective analysis of the clinical data of 529 patients who suffered from hospital delivery complicated by postpartum hemorrhage in the First Hospital of Shanxi Medical University from January 1,2019 to December 31,2021.According to the amount of blood loss,they were divided into mild postpartum hemorrhage group(group A,postpartum blood loss 500-1000 ml)and severe postpartum hemorrhage group(postpartum blood loss≥1000 ml).The latter group was divided into moderate severe postpartum hemorrhage group(group B,1000-2000ml postpartum blood loss)and severely severe postpartum hemorrhage(group C,≥2000 ml postpartum blood loss),including 224 cases,245 cases and 60 cases,respectively.Statistical analysis was carried out using χ~2 tests,logistic regression analysis,multiple linear stepwise regression analysis,and other methods.Results:1.A total of 529 cases of postpartum hemorrhage occurred in our hospital from 2019to 2021,and the incidence of postpartum hemorrhage was about 5.60%(529/9444).There were 305 cases of severe postpartum hemorrhage,with an incidence rate of 3.23%(305/9444),and 60 cases of severely severe postpartum hemorrhage,with an incidence rate of 0.64%(60/9444).2.Univariate analysis and comparison among the three groups of patients with different amounts of blood loss showed that there were statistically significant differences in 23 factors including age,conception mode and gestation weight gain(P<0.05).3.The above 23 factors were incorporated into the Logistic regression model.The results showed that assisted reproductive technology,irregular prenatal examination,excessive gestation weight gain,twin pregnancy,gestational hypertension and chronic hypertension,scarred uterus,previous history of postpartum hemorrhage,placenta previa,placenta accreta spectrum disorders were independent risk factors for increased blood loss in postpartum hemorrhage patients.≥2 births and pregnancy combined with subclinical hypothyroidism were the protective factors.4.The above 23 factors are included in the multivariate linear stepwise regression analysis,and all variance expansion factors are close to 1 and less than 10,indicating that there is no multicollinearity in the data.Adjust R~2=0.299.The results showed that the amount of blood loss in patients with postpartum hemorrhage was linearly reversed with the pernicious placenta previa,the number of birth weeks,placental implantation,the history of vaginal bleeding in the first trimester of pregnancy and the weight gain during pregnancy,of which the number of birth weeks was inversely correlated.From the standardized regression coefficient,it can be seen that the pernicious placenta previa has the greatest impact on the amount of blood loss.Conclusion:1.Fully understand the risk factors such as assisted reproduction,improper gestation weight gain,irregular obstetric examination during pregnancy,twin pregnancy,scarred uterus,the history of vaginal bleeding in the first trimester of pregnancy,and previous history of postpartum hemorrhage,and carry out reasonable publicity and guidance.2.For patients with placenta previa,placental implantation disease,and pernicious placenta previa,it is necessary to accurately assess the level of hospital treatment,and if necessary,refer to a hospital with corresponding treatment capabilities,prepare for perioperative rescue,and be vigilant against the occurrence of postpartum hemorrhage.3.For patients with hypertension and thyroid diseases during pregnancy,it is necessary to strengthen health care during pregnancy,so that early detection and treatment can be achieved,and timely and reasonable intervention can reduce the amount of blood loss during postpartum hemorrhage to a certain extent and reduce the occurrence of related adverse outcomes.4.For those at risk of preterm birth,prolonging the gestational age under the premise of ensuring the safety of the mother and fetus can reduce the amount of bleeding when pregnant women bleed after childbirth to a certain extent.