关键词: 产后出血, 流行病学, 重症监护病房, 影响因素分析, 二孩政策

Abstract: Background　With the implementation of the comprehensive two-child policy，the number of advanced age and critically ill parturient women have a significant increase in recent years，so it is very necessary to analyze the high risk factors of postpartum hemorrhage and the risk factors associated with ICU admission.It can effectively prevent the occurrence of postpartum hemorrhage and the resulting series of harms，thereby reducing the incidence of postpartum hemorrhage.Objective　To investigate the epidemiological characteristics of postpartum hemorrhage in pregnant women before and after the implementation of the comprehensive two-child policy in the north area of Guizhou province，and to further analyze the risk factors associated with ICU admission in pregnant women with postpartum hemorrhage.Methods　Taking the implementation of the comprehensive two-child policy on January 1，2016 as the time point，clinical data of patients with postpartum hemorrhage（961 cases） admitted to Affiliated Hospital of Zunyi Medical College during the comprehensive policy implementation time point were collected and retrospectively analyzed.Postpartum hemorrhage patients were compared before implementation（January 2014 to December 2015） and after the implementation（January 2016 to December 2017）．Clinical characteristics of patients before and after the implementation of the comprehensive two-child policy were collected，including age，senior age（≥35 years），maternal delivery，gestational weeks of delivery，regular checkups，scar uterus，mode of delivery，number of fetuses，incidence of hypertension during pregnancy，placenta previa，placenta adhesion/implantation，neonatal body weight，blood transfusion，hysterectomy，interventional therapy，drug therapy alone，ICU admission，bleeding volume，death and major bleeding causes.Multivariate Logistic regression analysis were used to identify possible factors affecting ICU admission.Results　After the implementation of the comprehensive two-child policy，the incidence of postpartum hemorrhage was significantly increased （P=0.029）；further comparison of clinical data of patients with postpartum hemorrhage found that after the implementation of the comprehensive policy，maternal age and advanced age，gestational times，delivery times，scar uterus，cesarean section，hypertensive disorder complicating pregnancy，placental adhesion/implantation，ICU admission and bleeding volume and uterine contraction in the ICU increased significantly （P<0.05）．Multiple Logistic regression showed that scar uterus〔OR=3.064，95%CI（1.877，5.033），P<0.001〕，hypertensive disorder complicating pregnancy〔OR=3.107，95%CI（1.721，5.608），P<0.001〕，placenta previa〔OR=1.901，95%CI（1.155，3.128），P=0.011〕，liver damage during pregnancy〔OR=14.718，95%CI（2.998，72.260），P=0.001〕 and combination with heart disease during pregnancy〔OR=20.535，95%CI（4.419，95.434），P<0.001〕 were independent risk factors of ICU admission in patients with postpartum hemorrhage.Conclusion　After the implementation of the comprehensive two-child policy，the incidence of postpartum hemorrhage has increased in the north area of Guizhou province.Advanced age，hypertensive disorder complicating pregnancy，scar uterus and placental adhesion/implantation are risk factors for postpartum hemorrhage；scar uterus，hypertensive disorder complicating pregnancy，placenta previa，pregnancy with heart disease and pregnancy with hepatic dysfunction are independent risk factors for ICU admission in postpartum hemorrhage.

Key words: Postpartum hemorrhage, Epidemiology, Intensive care units, Root cause analysis, Second child policy