浅谈晚期产后出血原因和防治.docVIP

浅谈晚期产后出血原因和防治 　　【摘 要】目的：探讨晚期产后出血时间、病因及防治措施。方法：对2008年1月至2012年12月收治的20例晚期产后出血病例进行回顾性分析。结果：19例晚期产后出血患者痊愈出院，1例抢救无效死亡。发病原因依次为：子宫复旧不良，胎盘胎膜、蜕膜残留，切口裂开或血肿，软产道裂伤，产后绒癌。发生时间以产后1.5天至2周者占多数（65%），少数病例?6周（5%）。结论：晚期产后出血的时间不应局限于产褥期内，其主要病因为子宫复旧不良和胎盘、胎膜及蜕膜残留；为了减少和避免晚期产后出血的发生，加强孕期保健、严格掌握剖宫产指征及时机、正确处理第三产程是关键。 【关键词】 晚期产后出血；原因分析；防治 Late Postpartum Hemorrhage Analysis of Causes and Prevention WANG Yan-yan1 YANG Bang-hui2 1.obstetrics and Gynecology，Maternal and child health hospital of Dianjiang County，Dianjiang，408300，Ch ongqingCity， China；2.obstetrics and Gynecology，Center Hospital of Jane Brook in Fuling district， Jane Brook，408008， ChongqingCity， China [Abstract]Objective：To investigate the time of late postpartum hemorrhage and its etiologyand treatment.Methods Clinical data of 20 cases of late postpartum hemorrhage from 2008 to 2012 were analyzed retrospectively .Results 19 cases of late postpartum hemorrhage were recovered， but one case was unable to save.Sub involution of uterus were tops the list of causes，fllowed by residual placenta and membranes or decidua，dehiscence of incision or hematoma，aceration of birth canal， postpartum choriocarcinoma.In most cases（65%），postpartum haemorrhage will occur after 1.5-2 days after childbirth and a few（5%） will occur after 6 weeks .Conclusion Late postpartum hemorrhage may occur beyond puerperium and the main causes are sub involution of uterus and residual placenta and membranes or decidua. In order to reduce or avoid the incidence of late postpartum hemorrhage， it is the key to strengthen maternal care， master the indication for cesarean section strictly and also deal with the third stage of labor correctly. [Key words] Latepueral hemorrhage；Cause analysis；Prevention and cure 产后出血发生在分娩后24小时后至产褥期末称晚期产后出血。以产后l～2周发病最常见，亦有迟至产后2月余发病[1]。和早期产后出血不同，晚期产后出血大多发生在家中，出血少时未引起重视，多时会危及生命，是产科严重的并发症之一，有时尽管用了各种可能的治疗手段也无法挽回产妇的生命。现对近五年收治的20例晚期产后出血病例进行回顾性分析，报道如下： 1 资料与方法 1.1 资料来源 2008年1月至2012年12月分娩总数为5072例，其中剖宫产2135例，自然分娩2937例，发生晚期产后出血20例。