Objective: To study the complications and intraoperative blood transfusion status of cesarean section in a tertiary hospital, and to explore the influencing factors of massive intraoperative blood transfusion. Methods: Retrospective analysis of cesarean section maternal blood transfusion in our hospital from 2017 to 2020. The blood transfusion rate, age, gestational age, body mass index(BMI) and complications were compared between different years. According to whether the transfusion of red blood cell(RBC) was more than 10 U, all the patients were divided into massive transfusion group and non massive transfusion group. Results: From 2017 to 2020, there were 4 990 cases of cesarean section, of which 335 cases received intraoperative blood transfusion, and the blood transfusion rate was 6.71%. The blood transfusion rate fluctuated in a V-shape in four years. The blood transfusion rate in 2017 and 2018 was significantly higher than that in 2019, and the difference was statistically significant(P<0.05). During the four years, the blood transfusion rate caused by placenta previa, anemia, preeclampsia and acute fatty liver of pregnancy fluctuated little, and the difference was not statistically significant(all P>0.05). The proportion of low-dose RBC(<10 U) transfusion in different years was more than 50%, but there was no significant difference in the proportion of RBC transfusion in different years(P>0.05). The proportion of age, previous cesarean section history, pernicious placenta previa and low coagulation function in the massive transfusion group were higher than those in the non massive transfusion group, and the proportion of singleton was lower than that in the non massive transfusion group, the differences were statistically significant(all P<0.05). Binary Logistic regression showed that age, history of cesarean section, pernicious placenta previa, multiple pregnancy and low coagulation function were independent factors of massive blood transfusion. The utilization rate of tranexamic acid in pregnant women with massive bleeding in different years showed an increasing trend year by year, and there was significant difference in postoperative hemoglobin between 2017 and 2020 and between 2018 and 2020(all P>0.05). Conclusion: In the past four years, the number of blood transfusion cases during cesarean section showed a decreasing trend, but the blood transfusion rate fluctuated in a V-shape. Age, history of cesarean section, dangerous placenta previa, multiple pregnancy, and low coagulation function were all independent influencing factors of massive blood transfusion during cesarean section. |
[1] ANDRIKOPOULOU M,D'ALTON M E.Postpartum hemorrhage:early identification challenges[J].Semin Perinatol,2019,43(1):11-17.
[2] 黄颖.红细胞血浆联合冷沉淀输注用于产后大出血疗效观察[J].临床血液学,2020,33(12):844-847.
[3] 蒋玲玲,刘颖蕾,刘曼华,等.凶险性前置胎盘致产后大出血患者的急症子宫切除术手术时机探讨[J].中华全科医学,2017,11(28):1915-1917.
[4] 王芳.高龄产妇产后大出血危险因素分析[J].中国妇幼保健,2020,35(5):843-845.
[5] ZHOU C,ZHANG L,BAO Y,et al.Effect of blood transfusion during cesarean section on postpartum hemorrhage in a tertiary hospital over a 4-year period[J].Medicine,2021,100(3):e23885.
[6] ANTOINE C,YOUNG B K.Cesarean section one hundred years 1920-2020:the good,the bad and the ugly[J].J Perinat Med,2020,49(1):5-16.
[7] ATTALI E,EPSTEIN D,REICHER L,et al.Mild thrombocytopenia prior to elective cesarean section is an independent risk factor for blood transfusion[J].Arch Gynecol Obstet,2021,304(3):627-632.
[8] ROUSE D J,MACPHERSON C,LANDON M,et al.Blood transfusion and cesarean delivery[J].Obstet Gynecol,2006,108(4):891-897.
[9] KOGUTT B K,VAUGHT A J.Postpartum hemorrhage:blood product management and massive transfusion[J].Semin Perinatol,2019,43(1):44-50
[10] RAO J,FAN D,ZHOU Z,et al.Maternal and neonatal outcomes of placenta previa with and without coverage of a uterine scar:a retrospective cohort study in a Tertiary Hospital[J].Int J Women's Health,2021,13:671-681
[11] FAN D,XIA Q,LIU L,et al.The incidence of postpartum hemorrhage in pregnant women with placenta previa:a systematic review and meta-analysis[J].PLoS One,2017,12(1):e0170194
[12] DOSEDLA E,GÁL P,CALDA P.Association between deficient cesarean delivery scar and cesarean scar syndrome[J].J Clin Ultrasound,2020,48(9):538-543
[13] 周梦琳,高华,马燕英,等.妊娠糖尿病产妇剖宫产术后大出血发生率及影响因素分析[J].中华现代护理杂志,2021,27(9):1210-1214.
[14] MUIRHEAD B,WEISS A D H.Massive hemorrhage and transfusion in the operating room[J].Can J Anaesth,2017,64(9):962-978
[15] 殷茵,陈恒,许晓红.产后大出血患者不同输血治疗方案的相关研究[J].长春中医药大学学报,2020,36(4):745-748.
[16] 王佳赟,郑文颖,杨雪.红细胞与冷沉淀不同比例输注在产后出血患者大量输血治疗中的临床效果观察[J].中国妇幼保健杂志,2020,35(21):1995-1998.
[17] HULSE W,BAHR T M,MORRIS D S,et al.Emergency-release blood transfusions after postpartum hemorrhage at the Inter Mountain Health Care Hospitals[J].Transfusion,2020,60(7):1418-1423
[18] HOLCOMB J B,TILLEY B C,BARANIUK S,et al.Transfusion of plasma,platelets,and red blood cells in a 1:1:1vs a 1:1:2 ratio and mortality in patients with severe trauma:the PROPPR randomized clinical trial[J].JAMA,2015,313(5):471-482. |