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目的了解成都市孕妇贫血状况及其变化规律,探讨孕妇贫血对产后出血的影响。方法采用纵向研究方法,选取成都市妇幼医疗机构产前门诊548名孕6~12周单胎健康孕妇为研究对象,通过问卷调查收集孕妇基本信息、孕产次及产后出血等资料,采用氰化高铁血红蛋白法测定孕妇各孕期血红蛋白含量,按照WHO孕妇贫血诊断标准(2011)诊断孕妇贫血,分析各孕期孕妇贫血状况及其变化规律,应用混合效应Logistic回归方法分析孕妇贫血对产后出血的影响。结果孕妇总贫血率为31.9%,孕早、中、晚期贫血率分别为5.5%、22.8%和18.2%,孕中、晚期贫血率显著高于孕早期,差异有统计学意义(P<0.05)。孕早、中、晚期均以轻度贫血为主(分别93.3%、78.4%和70.0%),无重度贫血。在控制妊娠年龄、分娩方式等混杂因素后,与非贫血孕妇组比较,孕晚期贫血孕妇组产后出血发生风险是非贫血孕妇组的6.47倍(95%CI 1.23~34.23),孕早、中期贫血对产后出血无显著性影响。结论成都市孕妇孕中晚期贫血问题亟待改善,孕晚期贫血可能是产后出血发生的独立危险因素。
Objective To understand the status and changes of anemia in pregnant women in Chengdu and explore the influence of anemia in pregnant women on postpartum hemorrhage. Methods A longitudinal study was conducted to select 548 pregnant women with singletonic pregnancies ranging in age from 6 to 12 weeks in prenatal clinics in Chengdu MCH hospital. The questionnaires were used to collect the basic information of pregnant women, maternity and postpartum hemorrhage, The level of hemoglobin in pregnant women was determined by methemoglobin method. The anemia of pregnant women was diagnosed according to WHO Diagnostic Criteria for Anemia of Pregnant Women (2011). The anemia status of pregnant women during pregnancy was analyzed. The effect of anemia of pregnant women on postpartum hemorrhage was analyzed by mixed effect Logistic regression. Results The total anemia rate in pregnant women was 31.9%. The rates of anemia in early, middle and late stages of pregnancy were 5.5%, 22.8% and 18.2%, respectively. The rates of anemia in middle and late pregnancy were significantly higher than those in early pregnancy (P <0.05) . Pregnancy early, middle and late were mild anemia (93.3%, 78.4% and 70.0%, respectively), no severe anemia. The risk of postpartum hemorrhage in pregnant women with third trimester anemia was 6.47 times (95% CI 1.23 to 34.23) in pregnant women with non-anemia compared with those in non-anemic pregnant women after controlling for confounding factors such as gestational age and mode of delivery. Postpartum hemorrhage no significant effect. Conclusion The problem of anemia in pregnant women in the second trimester of pregnancy needs to be improved urgently. Anemia of third trimester may be an independent risk factor of postpartum hemorrhage.