| Objective:To evaluate the etiopathogenisis, risk factor, treatment and prevention of postpartum hemorrhage (PPH).Methods:Retrospective analysis was made in 243 cases of PPH that admited in The First Affiliated Hospital of Chongqing Medical University Hospital during January, 2006 to October, 2009. Over 50 parametes were designed to evaluate the epidemiology, clinical features and treatment of PPH.Results:The morbidity of PPH in our hospital was 1.72%.The causes of PPH: uterine inertia, placenta accreta, placental adherence, placental retention, bleeding of placental separation surface, coagulation disorders, uterus incision hemorrhage, soft birth canal injury, rupture of uterus, inversion of uterus. The morbidity of PPH of vaginal birth was 0.99%, of obstetric forceps was 2.71%, and of cesarean section was 1.91%, which were significantly different (P<0.05). The respective morbidities of PPH of anaemia, placenta praevia, multiple pregnancy and hepatitis were 23.42%, 20.00%, 4.98% and 4.03%, which were significantly different than ones of PPH patients without these diseases(P<0.05). 95.88% of the PPH onset within 2 hours after childbirth. The effective rate of managemengt of PPH: massage uterus was 28.40%, tamping was 71.79%,B-lynch suture was 92.86%. 35 cases (14.40%, 34/243) were operated hysterectomy; the morbidity of hemorrhagic shock was 18.11%. 40 cases (16.46%, 40/243) admitted in intensive care unit (ICU) for monitoring. 1 patient was died of severe DIC. Neonatal case-fatality rate was 15.15‰Conclusion:Uterine inertia and placental factor are the main reasons of PPH, and obstetric pathology is the risk factor. Tamping and B-lynch suture are effective treatments of PPH. Dealing with the causes of PPH actively aims to prevent serious complication. Objective:To evaluate the etiopathogenisis, risk factor, surgical occasion and manner of Hysterectomy after PPH.Methods : Retrospective analysis was made in 35 cases of hysterectomy afer PPH that admited in The First Affiliated Hospital of Chongqing Medical University Hospital during January, 2006 to October, 2009. Over 50 parametes were designed to evaluate the epidemiology, clinical features and treatment of hysterectomy after PPH.Results:The morbidity of hysterectomy after PPH in our hospital was 0.18%. Causes of hysterectomy after PPH: placenta increta, placental adherence, uterine inertia, coagulation disorders and soft birth canal injury. The delivery mode of hysterectomy patients was cesarean section who deliveried in our hospital. The age of PPH patients in hysterectomy group 32.09±5.60 years old was significantly higer than uterus reservation group(P<0.05). The respective morbidities of hysterectomy in placenta praevia and scared uterus were 25.81% and 36.36%, which were significantly different than ones without these diseases(P<0.05). 22 cases (62.85%, 22/35) were chosen subtotal hysterectomy. 25cases (71.43%, 25/35) got bleeding over 2000ml. 29 cases (82.86%, 29/35) fell hemorrhagic shock. 1 patient was died of severe DIC.Conclusion:Hysterectomy is a vital management to save emergency and severe PPH patients'lives. Placental disorder and uterine inertia are the main indications of emergency hysterectomy. Age, cesarean section, placenta praevia and scared uterus are the risk factors of hysterectomy after PPH. STU is preferred in obstetric hysterectomy. We should actively manage PPH causes to prevenet severe obstetrical complication. Objective:To evaluate the risk factor of severe PPH admitted in ICU and treatment for obstetrics emergency cases.Methods: Retrospective analysis was made in 40 cases of severe PPH that admitted in The First Affiliated Hospital of Chongqing Medical University Hospital during January, 2006 to October, 2009. Over 50 parametes were designed to evaluate the epidemiology, clinical features and treatment of severe PPH.Results: The ratio of sever PPH cases admitting in PPH patients was 16.46%. 23 cases (57.50%, 23/40) were labored in other hospital. The rate of PPH cases admitting in ICU in our hospital was 0.16% (17/10859). The delivery modes of severe PPH patients were all cesarean section who deliveried in our hospital. The main reason of severe PPH patients admitted ICU was hemorrhagic shock (33 cases, 82.50%), including DIC, ARDS and MODS. The follows were placenta increta (4 cases, 10.00%), cardiac insufficiency (1 case, 2.50%), hyperthyroidism combining mild eclampsism (1 case, 2.50%) and cardiorespiratory resuscitation (1 case, 2.50%). Most patients got at least one system or organ dysfunction, and DIC was the most common with ratio of 50.00%. 24 cases (60.00%, 24/40) got bleeding over 2000ml. The severe PPH patients were infused packed red blood cells 2544.74±1782.6ml, plasma 1484.85±951.0ml, platelet 2.7±2.3U and cryoprecipitate 7.30±10.2U. 14 cases (35.00%, 14/40) used nasal oxygen catheters for oxygen, 4 cases (10.00%, 4/40) used non-invasive ventilator (CPAP mode), 22 cases (55.00%, 22/40) used invasive ventilator (SIMV mode). The utilization ratio of ventilator was 65.00% in PPH patients entering in ICU. Neonatal case-fatality rate in our hospital was 52.63‰.Conclusion:The main reason of severe PPH patients admitting in ICU was hemorrhagic shock. Sever PPH is one of the important cause of DIC. Intensive life support and component transfusion are the important steps to cure severe PPH. Cooperate between ICU staff and Obstetrician is also the effective way to treat critical pregnancies.
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