Clinical Data Analysis Of 139 Cases With Severe Postpartum Hemorrhage And Follow-up

To explore the causes of severe postpartum hemorrhage and the risk factors of severe postpartum hemorrhage,to understand the menstruation changes of severe postpartum hemorrhage at before and after delivery,and the effect of different treatments for menstruation after 1 year,to provide cilnical data for prevention and treatment of severe postpartum hemorrhage.Methods1 From January 2011 to December 2016,totally 139 patients with severe postpartum hemorrhage in Nanjing liuhe district people's hospital were selected as the subjects,the causes,its risk factors and treatment methods of severe postpartum hemorrhage were analyzed by clinical characteristics of these cases.A total of 137 parturients who retained the uterus were followed up,the changes of menstruation the before and after delivery were compared,and the changes of menstruation were compared between B-Lynch suture group and intrauterine gauze packing group within 1 year.2 The SPSS 19.0 software was used to analyze the data,the?~2 test,t-test of independent samples,single factor and multifactor Logistic regression were performed for statistical analysis.Results1 The incidence rate of uterine inertia was 58.99%(82/139),which was major causes of postpartum hemorrhage;there were significant differences in the blood volume in different bleeding causes(P<0.05),and the coagulation dysfunction,placental factors were significantly more than that of uterine inertia(P<0.05).The cause of bleeding was independent risk factors for severe postpartum haemorrhage volume(P<0.05),which included coagulation dysfunction,birth canal injury,placenta factors and uterine inertia according to the sequence of sorting.2 In 139 cases of this study,including 57 cases of vaginal delivery,the average volume of bleeding was(1358.68±363.64)ml,and 82 cases underwent cesarean delivery the average volume of bleeding was(1532.07±912.12)ml,the average volume of bleeding of cesarean delivery was higher than vaginal delivery,there was no significant difference between different delivery.3 The number of 76,40,20 parturients were effectively hemostatic by with uterotonics,uterotonics+intrauterine gauze packing,uterotonics+B-Lynch suture respectively.There was 2 cases were performed with uterotonics+B-Lynch suture+uterine artery ligation were uterotonic,1 case were effectively hemostatic,1 case accepted subtotal hysterectomy due to hemorrhagic shock,1 case accepted subtotal hysterectomy due to hysterorrhexis,the total effective rate was 98.56%(137/139).4 The lochia lasted for(36.43±7.25)d averagely,the average recovery time of menstruation were(82.50±10.48)d.The lasted time of lochia in postpartum,the recovery time of menstruation,the postpartum period and the days of menstruation of the two groups were no significant differences(P>0.05).5 The incidence rate of puerperas was 1.46%(2/137)before delivery,after delivery,the incidence rate was 6.57%,there was significant difference between two groups(?~2=4.641,P=0.031).The incidence rate of severe Sheehan's syndrome was 0.72%(1/137).Conclusions1 The uterine inertia is the main cause of postpartum hemorrhage.2 The cause of bleeding is independent factors of severe postpartum haemorrhage volume,including coagulation dysfunction,birth canal injury,placental factors,uterine inertia.3 For severe postpartum haemorrhage,the drugs and different surgical methods should be timely applied according to the different bleeding causes.Through the properly manegements,no obvious influences on conditions of prenatal and postpartum,menstruation of parturients after 1 year.