单胎重度子痫前期孕妇产后出血的危险因素及预测指标

doi:10.3969/j.issn.1006-5725.2025.08.010

Abstract

Abstract:

Objective To analyze the risk factors and effective predictive indicators for postpartum hemorrhage （PPH） in pregnant women with severe pre-eclampsia （sPE） in singleton pregnancies. The findings will serve as a valuable reference for the clinical prevention and management of PPH in these patients. Methods A retrospective analysis was conducted on 932 pregnant women with sPE at two tertiary hospitals in Guangzhou from January 1， 2016， to December 31， 2022. Among these， 95 cases were complicated by PPH. A comparative analysis was performed between the sPE group and the sPE with PPH group. Results （1） The incidence of assisted reproductive technology， intrapartum blood loss， placental abruption， elevated D-dimer levels， increased monocyte counts， and higher SIRI levels were significantly higher in the PPH group， whereas platelet counts were significantly lower （P < 0.05）. （2） The results indicated that intrapartum blood loss， D-dimer levels， and platelet counts were independently associated with PPH in pregnant women with sPE. （3） The area under the curve （AUC） for intrapartum blood loss， D-dimer， and platelet counts were 0.805， 0.717， and 0.571， respectively. The optimal cutoff value for D-dimer was determined to be 2.295 μg/mL. The combined AUC for intrapartum blood loss and D-dimer was 0.859. （4） Intrapartum blood loss values were significantly higher in the PPH group for both vaginal delivery and cesarean section （P < 0.001）. The corresponding optimal cutoff values were 285 mL and 375 mL， respectively. Conclusions Intrapartum haemorrhage， D-dimer levels， and platelet count were identified as independent risk factors for PPH in pregnant women with sPE. Specifically， pregnant women with sPE who experienced blood loss exceeding 285 mL during vaginal delivery or 375 mL during caesarean section， along with a D-dimer level greater than 2.295 μg/mL， demonstrated an increased likelihood of developing PPH. Therefore， it is crucial to enhance clinical monitoring of these relevant indicators in high-risk populations.

Key words: preeclampsia, postpartum pemorrhage, pregnant women, risk factor analysis, predictive indicator

CLC Number:

Yunting ZHUANG,Yao SONG,Qian CHEN,Yanxuan XIAO,Tian TAN,Wenhui LI,Ruiyan BAI,Zeshan LIN,Zhijian. WANG. Risk factor analysis and predictive indicators of postpartum haemorrhage in singleton pregnant women with severe preeclampsia[J]. The Journal of Practical Medicine, 2025, 41(8): 1155-1160.

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References 33

1	中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠高血压期疾病诊治指南（2020）［J］. 中华妇产科杂志， 2020， 55（4）： 227-238.
2	RANA S， LEMOINE E， GRANGER J P， et al. Preeclampsia： Pathophysiology， Challenges， and Perspectives［J］. Circ Res， 2019， 124（7）：1094-1112. doi:10.1161/circresaha.118.313276 doi: 10.1161/circresaha.118.313276
3	SUN F， HAN B， CHEN Y， et al. Development and external validation of a model for predicting adverse outcomes in women with preeclampsia： A retrospective study from two trans-regional centers in China［J］. Pregnancy Hypertens， 2021， 26：133-140. doi:10.1016/j.preghy.2021.10.008 doi: 10.1016/j.preghy.2021.10.008
4	阮焱，范玲. 重度子痫前期产后管理、远期预后及再发风险评估［J］. 中国实用妇科与产科杂志，2011，27（12）：910-913.
5	刘陈，齐俊巧，侯雪晶，等. 临床不典型子痫前期患者发生的危险因素分析与围产结局的关系［J］. 中国妇产科临志，2024，25（3）：257-259.
6	中华医学会妇产科学分会妊娠期高血压疾病学组. 产后出血预防与处理指南（2023）［J］. 中华妇产科杂志， 2023， 58（6）： 401-409.
7	NEARY C， NAHEED S， MCLERNON D J， et al. Predicting risk of postpartum haemorrhage： A systematic review［J］. BJOG， 2021， 128（1）：46-53. doi:10.1111/1471-0528.16379 doi: 10.1111/1471-0528.16379
8	谢幸，孔北华，段涛. 妇产科学［M］. 北京：人民卫生出版社， 2018.
9	HU B， YANG X R， XU Y， et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma［J］. Clin Cancer Res， 2014， 20（23）：6212-6222. doi:10.1158/1078-0432.ccr-14-0442 doi: 10.1158/1078-0432.ccr-14-0442
10	QI Q， ZHUANG L， SHEN Y， et al. A novel systemic inflammation response index （SIRI） for predicting the survival of patients with pancreatic cancer after chemotherapy［J］. Cancer， 2016， 122（14）：2158-2167. doi:10.1002/cncr.30057 doi: 10.1002/cncr.30057
11	WANG N， REN L， LI Z， et al. The association between SII and aging： Evidence from NHANES 1999-2018［J］. Front Public Health， 2024， 12：1418385. doi:10.3389/fpubh.2024.1418385 doi: 10.3389/fpubh.2024.1418385
12	GAO C， GAO S， ZHAO R， et al. Association between systemic immune-inflammation index and cardiovascular-kidney-metabolic syndrome［J］. Sci Rep， 2024， 14（1）：19151. doi:10.1038/s41598-024-69819-0 doi: 10.1038/s41598-024-69819-0
13	杨怡珂，郭晓玥，王妍，等. 产后出血孕产妇会诊与转诊策略［J］. 中国实用妇科与产科杂志，2024，40（10）：969-973.
14	POON L C， SHENNAN A， HYETT J A， et al. The International Federation of Gynecology and Obstetrics （FIGO） initiative on pre-eclampsia： A pragmatic guide for first-trimester screening and prevention［J］. Int J Gynaecol Obstet， 2019， 145（Suppl 1）：1-33. doi:10.1002/ijgo.12892 doi: 10.1002/ijgo.12892
15	BOKSLAG A， VAN WEISSENBRUCH M， MOL B W， et al. Preeclampsia； Short and long-term consequences for mother and neonate［J］. Early Hum Dev， 2016， 102：47-50. doi:10.1016/j.earlhumdev.2016.09.007 doi: 10.1016/j.earlhumdev.2016.09.007
16	RANA S， BURKE S D， KARUMANCHI S A. Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders［J］. Am J Obstet Gynecol， 2022， 226（2S）：S1019-S1034. doi:10.1016/j.ajog.2020.10.022 doi: 10.1016/j.ajog.2020.10.022
17	向金凤，王一枭，贾瑞喆. 重度子痫前期发生产后出血的危险因素分析［J］. 重庆医学，2025，54（1）：148-152，157.
18	TANIGUCHI M， AKINAGA C， SUZUKI K， et al. The effect of assisted reproductive technology on postpartum bleeding： Hormonal cycle frozen embryo transfer might increase blood loss［J］. J Anesth， 2024， 38（1）：19-28. doi:10.1007/s00540-023-03268-3 doi: 10.1007/s00540-023-03268-3
19	罗世君，张丽姿，陈敦金. 重视非创伤性因素的胎盘植入性疾病的识别和防治［J］. 实用医学杂志，2024，40（21）：2971-2975.
20	张露露. 重型胎盘早剥的临床资料回顾性分析［D］. 长春：吉林大学，2019.
21	吕艳，陈艳，赖晓珺. 血清STOX1可溶性血管内皮细胞生长因子受体1及血栓调节蛋白对早发型重度子痫前期并发胎盘早剥的预测分析［J］. 中国妇幼保健，2024，39（7）：1174-1178.
22	董莉莳，何荣霞. 妊娠期血小板减少症患者分娩前后凝血功能分析［J］. 实用医学杂志，2023，39（7）：866-869，874.
23	VAN DIJK W E M， NIJDAM J S， HAITJEMA S， et al. Platelet count and indices as postpartum hemorrhage risk factors： A retrospective cohort study［J］. J Thromb Haemost， 2021， 19（11）：2873-2883. doi:10.1111/jth.15481 doi: 10.1111/jth.15481
24	姜海，陈练，赵扬玉. 凝血-免疫-炎症交互作用与产后出血关系的研究进展［J］. 中华妇产科杂志， 2021， 56（2）： 149-152.
25	范倩倩.PLR、NLR联合血栓弹力图在妊娠合并血小板减少症患者母婴不良结局中的预测价值［D］.兰州：兰州大学，2023.
26	KATZ D， FARBER M K. Can measuring blood loss at delivery reduce hemorrhage-related morbidity？［J］. Int J Obstet Anesth， 2021， 46：102968. doi:10.1016/j.ijoa.2021.102968 doi: 10.1016/j.ijoa.2021.102968
27	ANDRIKOPOULOU M， D'ALTON M E. Postpartum hemorrhage： Early identification challenges［J］. Semin Perinatol， 2019， 43（1）：11-17. doi:10.1053/j.semperi.2018.11.003 doi: 10.1053/j.semperi.2018.11.003
28	ZHENG C， YUE P， CAO K， et al. Predicting intraoperative blood loss during cesarean sections based on multi-modal information： A two-center study［J］. Abdom Radiol （NY）， 2024， 49（7）：2325-2339. doi:10.1007/s00261-024-04419-0 doi: 10.1007/s00261-024-04419-0
29	林岚，刘路浩，张磊，等.D-二聚体在胰肾联合移植术后移植胰血栓形成的预测价值［J］.实用医学杂志，2022，38（16）：2071-2075. doi:10.3969/j.issn.1006-5725.2022.16.017 doi: 10.3969/j.issn.1006-5725.2022.16.017
30	YOUSSEF L， MIRANDA J， BLASCO M， et al. Complement and coagulation cascades activation is the main pathophysiological pathway in early-onset severe preeclampsia revealed by maternal proteomics［J］. Sci Rep， 2021， 11（1）：3048. doi:10.1038/s41598-021-82733-z doi: 10.1038/s41598-021-82733-z
31	钱天烨. 联合检测妊娠晚期孕妇D-二聚体及凝血四项的临床意义研究［D］. 扬州：扬州大学，2020.
32	SHAO H， GAO S， DAI D， et al. The association of antenatal D-dimer and fibrinogen with postpartum hemorrhage and intrauterine growth restriction in preeclampsia［J］. BMC Pregnancy Childbirth， 2021， 21（1）：605. doi:10.1186/s12884-021-04082-z doi: 10.1186/s12884-021-04082-z
33	梁润仪，李映桃，李柱. 晚期产后出血的临床特征分析［J］. 热带医学杂志，2017，17（8）：1071-1074.

临床特征	sPE组（n = 837）	sPE并发PPH组（n = 95）	t/χ² 值	P值
年龄/岁	31.10 ± 5.23	32.12 ± 5.28	1.781	0.073
月经不规律/［例（%）］	78（9.30）	12（12.6）	1.124	0.289
产前BMI/（kg/m²）	28.76 ± 4.07	29.41 ± 4.25	1.457	0.146
初孕妇/［例（%）］	318（38.0）	38（40.0）	0.146	0.703
初产妇/［例（%）］	450（53.8）	53（55.8）	0.146	0.707
辅助生殖/［例（%）］	117（14.0）	22（23.2）	5.665	0.017
瘢痕子宫/［例（%）］	153（18.3）	21（22.1）	0.822	0.364
PE病史/［例（%）］	31（3.7）	4（4.2）	0.059	0.809
慢性高血压/［例（%）］	123（14.7）	12（12.6）	0.293	0.588
收缩压/mmHg	159.27 ± 18.69	161.21 ± 21.03	-1.070	0.285
舒张压/mmHg	95.44 ± 13.58	98.01 ± 14.86	-1.607	0.108
采样孕周/周	36.34 ± 3.59	36.69 ± 2.47	0.777	0.437
分娩孕周/周	36.66 ± 3.50	36.91 ± 2.46	0.672	0.502
妊娠糖尿病/［例（%）］	237（28.3）	29（30.5）	0.204	0.651
剖宫产/［例（%）］	608（72.6）	77（81.1）	3.100	0.078
胎膜早破/［例（%）］	114（13.6）	9（9.5）	1.280	0.258
胎盘早剥/［例（%）］	39（4.7）	9（9.5）	4.048	0.044
胎儿体质量/kg	2.60 ± 0.74	2.65 ± 0.63	-0.818	0.413
胎儿生长受限/［例（%）］	204（24.4）	16（16.8）	2.683	0.101
NICU转入/［例（%）］	390（46.6）	45（47.4）	0.021	0.886
产时出血量/mL	274.55 ± 74.55	404.41 ± 146.51	14.169	< 0.001

指标	sPE组（n = 837）	sPE并发PPH组（n = 95）	t值	P值
纤维蛋白原/（g/L）	4.55 ± 0.94	4.47 ± 1.25	-0.720	0.472
DD/（μg/mL）	1.39 ± 1.93	3.29 ± 3.73	8.819	< 0.001
LYC/（×10⁹/L）	1.95 ± 1.01	2.00 ± 1.09	0.400	0.689
NEUT/（×10⁹/L）	8.17 ± 2.73	8.07 ± 3.21	-0.306	0.759
MONO/（×10⁹/L）	0.73 ± 0.31	0.84 ± 0.39	3.188	0.001
PLT/（×10⁹/L）	237.60 ± 64.79	219.63 ± 60.04	-2.582	0.010
SII	1 126.31 ± 674.91	1 069.41 ± 824.40	-0.761	0.447
SIRI	3.25 ± 1.73	3.93 ± 2.89	3.372	0.026

项目	β	SE	Wald χ²	OR（95% CI）	P值
辅助生殖	-0.211	0343	0.379	0.810（0.414 ~ 1.585）	0.538
胎盘早剥	1.117	0.664	2.827	3.055（0.831 ~ 11.226）	0.093
产时出血量	0.015	0.002	78.226	1.015（1.012 ~ 1.019）	< 0.001
DD	0.238	0.044	29.446	1.268（1.164 ~ 1.382）	< 0.001
MONO	0.544	0.537	1.763	1.724（0.772 ~ 3.850）	0.184
PLT	-0.006	0.002	7.088	0.993（0.988 ~ 0.998）	0.008
SIRI	0.090	0.065	1.905	1.063（0.910 ~ 1.241）	0.168

项目	产时出血量/mL	t值	P值
阴道分娩		3.643	< 0.001
sPE（n = 221）	222.76 ± 70.91
sPE并发PPH（n = 18）	333.33 ± 127.19
剖宫产		7.565	< 0.001
sPE（n = 616）	293.13 ± 66.69
sPE并发PPH（n = 77）	421.03 ± 146.47

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Risk factor analysis and predictive indicators of postpartum haemorrhage in singleton pregnant women with severe preeclampsia

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