Factors Analysis And Nursing Countermeasures Study For Risks Of Cesarean Section In Perioperative Period

Objective A retrospective study was performed in 1026 women with cesarean section among 2218 pregnancy from January 1,2014 to May 31,2015 in a large and comprehensive hospital in Tianjin.Taking NA,hemorrhage during cesarean section and PPH for example,this study investigated the main risks during cesarean section,analyzed the relative factors,and put forward the nursing countermeasures,so as to strengthen the control of nursing risk in perioperative period of cesarean section,improve the ability of nursing risk management in obstetric and make sure the security of mother and infant.Methods Documentation method was used to analyze the status quo and progress of nursing risk management of obstetric in China and abroad,so as to offer the evidence for nursing countermeasures during perioperative period in cesarean section.A retrospective study was performed in 1026 pregnancy with cesarean section.T test,chi-square test or Fisher`s exact test,logistic regression analysis were used to find the corresponding risk factors and countermeasures of neonatal asphyxia(NA),hemorrhage during cesarean section and postpartum hemorrhage(PPH)by SPSS 18.0.Finally,according to the above research,we formulate nursing countermeasures of risk during perioperative period in cesarean section,so as to provide an important basis for obstetric risk management.Results The incidence of NA was 2.14%(22/1026),including of 19 cases with mild asphyxia and 3 cases with severe asphyxia.6 factors had statistical significance using univariate analysis.They were oligohydramnios(?2=6.210,P < 0.05),premature delivery(?2=30.83,P < 0.01),low birth weight(P < 0.01),fetal malpresentation(?2=51.44,P < 0.01),antepartum hemorrhage(P < 0.05)and fetal distress(P < 0.01).Binary logistic analysis showed that fetal distress(OR=263.657,95%CI 38.645~1798.789),fetal malpresentation(OR=25.427,95%CI 8.071~80.109),premature delivery(OR=14.909,95%CI 4.522~49.155),antepartum hemorrhage(OR=11.017,95%CI 2.023~59.989),meconium stained amniotic fluid(OR=6.016,95%CI 1.569~23.064)were risk factors.214 women were diagnosed with hemorrhage during cesarean section among 1026 cases(20.86%).6 factors had statistical significance using univariate analysis.They were placenta previa(?2=9.846,P < 0.01),hypothyroidism during pregnancy(?2=7.819,P<0.01),hypertensive disorders in pregnancy(?2=5.500,P < 0.05),multiple pregnancy(?2=10.252,P < 0.01),uterine myoma(?2=5.374,P < 0.05)and antenatal care(t=2.148,P < 0.05).Binary logistic analysis showed that placenta previa(OR=5.958,95%CI1.649~21.522),multiple pregnancy(OR=4.399,95%CI 1.556~12.431),hypothyroidism during pregnancy(OR=2.385,95%CI 1.119~5.081),gestational hypertension(OR=1.934,95%CI 1.034~3.651)were risk factors.There were 24 cases of PPH among 1026 women and the incidence of PPH was 2.34%.2 factors had statistical significance using univariate analysis.They were placenta adherence(P<0.05)and placenta previa(P<0.05).Binary logistic analysis showed that placenta previa(OR=10.379,95%CI1.913~56.311),multiple pregnancy(OR=6.768,95%CI 1.357~33.758),gestational hypertension(OR=6.755,95%CI 1.695~26.915)were risk factors.Conclusions1.This study found that fetal distress was the most important of independent factors of NA among pregnancy during cesarean section.The others were fetal malpresentation,premature delivery,antepartum hemorrhage and meconium stained amniotic fluid.The corresponding nursing countermeasures were guiding prenatal care scientifically,observing labor progress strictly,preventing meconium stained amniotic fluid effectively and preparing for rescuing the newborn timely.2.Placenta previa was the most important of independent factors of hemorrhage during cesarean section.The others were multiple pregnancy,hypothyroidism during pregnancy and gestational hypertension.The corresponding nursing countermeasures were increasing the frequency of prenatal care of high-risk pregnancy,diagnosing placenta previa as soon as possible,strengthening clinical nutrition intervention and weight management and controlling gestational hypertension effectively.3.Placenta previa was the most important of independent factors of PPH.The others were multiple pregnancy and gestational hypertension.The corresponding nursing countermeasures were implementing the clinical nursing path during cesarean section,diagnosing and disposing placenta previa as soon as possible and carrying out psychological care actively in perioperative period.