Abstract：
OBJECTIVE: The goal of this study was to identify the risk factors associated with puerperal genital hematoma (PGHA) and analyze the management strategies employed and the resulting maternal outcomes.
METHODS: This retrospective cohort study examined the pregnant women delivering vaginally with PGHA in Peking University Third Hospital during January 2002 to December 2021. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. Independent-samples t-test was performed for continuous variables. Chi-squared test was performed to compare categorical data.
RESULTS: A total of 47 women with PGHA were included, and 94 matched controls were enrolled during the same study period. Compared with the control group, labor induction (34.0% vs. 9.6%, P = 0.000) and episiotomy (66.0% vs. 31.9%, P = 0.000) were more frequently performed in PGHA cases. There was a significantly higher incidence of postpartum hemorrhage (PPH) (53.2% vs. 6.4%, P = 0.000) in PGHA patients than in controls. Compared with the patients with <5 cm hematoma, the proportion of prenatal anemia (25.8% vs. 0.0%, P = 0.027) and the incidence of PPH (67.7% vs. 25.0%, P = 0.005) were significantly higher in patients with ≥5 cm hematoma. In comparison, the active period was significantly shorter (3.1 ± 1.9 vs. 5.1 ± 3.0, P = 0.031) in patients with ≥5 cm hematoma. There were significant differences in perineal pain and swelling (31.3% vs. 67.7%, P = 0.017), vulva hematoma (93.8% vs. 48.4%, P = 0.002) and surgical treatment (62.5% vs. 96.8%, P = 0.002). Nearly half of the patients in the ≥5 cm group underwent secondary suture (41.9% vs. 6.3%, P = 0.011). In patients with PGHA detected after more than 2 h, the body mass index was substantially higher (24.5 ± 4.3 vs. 21.4 ± 2.7, P = 0.011), and the weight gain during pregnancy (14.1 ± 4.3 vs. 11.4 ± 3.5, P = 0.021) was significantly lower. Compared with the patients in PGHA without PPH, age (31.7 ± 4.4 vs. 29.4 ± 2.6, P = 0.033) and newborn birth weight (3367 ± 390 g vs. 3110 ± 419 g, P = 0.045) were considerably higher in PGHA cases with PPH, and the platelet count ([182 ± 44] × 109/L vs. [219 ± 51] × 109/L, P = 0.015) was significantly lower.
CONCLUSIONS: Pregnant women who underwent labor induction and episiotomy had a higher incidence of PGHA. The PGHA-related PPH rate is significantly increased. Active surgical treatment is recommended for patients with ≥5 cm hematoma.
METHODS: This retrospective cohort study examined the pregnant women delivering vaginally with PGHA in Peking University Third Hospital during January 2002 to December 2021. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. Independent-samples t-test was performed for continuous variables. Chi-squared test was performed to compare categorical data.
RESULTS: A total of 47 women with PGHA were included, and 94 matched controls were enrolled during the same study period. Compared with the control group, labor induction (34.0% vs. 9.6%, P = 0.000) and episiotomy (66.0% vs. 31.9%, P = 0.000) were more frequently performed in PGHA cases. There was a significantly higher incidence of postpartum hemorrhage (PPH) (53.2% vs. 6.4%, P = 0.000) in PGHA patients than in controls. Compared with the patients with <5 cm hematoma, the proportion of prenatal anemia (25.8% vs. 0.0%, P = 0.027) and the incidence of PPH (67.7% vs. 25.0%, P = 0.005) were significantly higher in patients with ≥5 cm hematoma. In comparison, the active period was significantly shorter (3.1 ± 1.9 vs. 5.1 ± 3.0, P = 0.031) in patients with ≥5 cm hematoma. There were significant differences in perineal pain and swelling (31.3% vs. 67.7%, P = 0.017), vulva hematoma (93.8% vs. 48.4%, P = 0.002) and surgical treatment (62.5% vs. 96.8%, P = 0.002). Nearly half of the patients in the ≥5 cm group underwent secondary suture (41.9% vs. 6.3%, P = 0.011). In patients with PGHA detected after more than 2 h, the body mass index was substantially higher (24.5 ± 4.3 vs. 21.4 ± 2.7, P = 0.011), and the weight gain during pregnancy (14.1 ± 4.3 vs. 11.4 ± 3.5, P = 0.021) was significantly lower. Compared with the patients in PGHA without PPH, age (31.7 ± 4.4 vs. 29.4 ± 2.6, P = 0.033) and newborn birth weight (3367 ± 390 g vs. 3110 ± 419 g, P = 0.045) were considerably higher in PGHA cases with PPH, and the platelet count ([182 ± 44] × 109/L vs. [219 ± 51] × 109/L, P = 0.015) was significantly lower.
CONCLUSIONS: Pregnant women who underwent labor induction and episiotomy had a higher incidence of PGHA. The PGHA-related PPH rate is significantly increased. Active surgical treatment is recommended for patients with ≥5 cm hematoma.
摘要：
目的：本研究的目的是确定与产褥期生殖器血肿（PGHA）相关的危险因素，并分析所采用的管理策略和由此产生的产妇结局。
方法：这项回顾性队列研究检查了2002年1月至2021年12月在北京大学第三医院接受PGHA阴道分娩的孕妇。进行探索性数据分析以评估平均值，标准偏差(SD)，频率,百分比和百分位数。对连续变量进行独立样本t检验。进行卡方检验以比较分类数据。
结果：共纳入47名PGHA患者，在同一研究期间纳入了94名匹配的对照。与对照组相比,引产(34.0%vs.9.6%,P=0.000）和会阴切开术（66.0％vs.31.9%,P=0.000）在PGHA病例中更常见。产后出血（PPH）的发生率明显较高（53.2%vs.6.4%,PGHA患者的P=0.000）。与血肿<5cm的患者相比，产前贫血的比例(25.8%vs.0.0%,P=0.027）和PPH的发生率（67.7％vs.25.0%,P=0.005）在≥5cm血肿患者中明显更高。相比之下,活跃期明显缩短(3.1±1.9vs.≥5cm血肿患者为5.1±3.0,P=0.031)。会阴疼痛和肿胀有显著差异(31.3%vs.67.7%,P=0.017),外阴血肿（93.8%vs.48.4%,P=0.002）和手术治疗（62.5%vs.96.8%,P=0.002)。≥5cm组中近一半的患者接受了二次缝合(41.9%vs.6.3%,P=0.011)。在超过2小时后检测到PGHA的患者中，体重指数明显较高（24.5±4.3vs.21.4±2.7,P=0.011),和孕期体重增加（14.1±4.3vs.11.4±3.5，P=0.021）明显降低。与无PPH的PGHA患者相比，年龄(31.7±4.4vs.29.4±2.6，P=0.033）和新生儿出生体重（3367±390gvs.3110±419g,P=0.045）在PGHA伴PPH的病例中明显更高，和血小板计数([182±44]×109/Lvs.[219±51]×109/L,P=0.015)显著降低。
结论：行引产和会阴切开术的孕妇PGHA发生率较高。PGHA相关的PPH率显著增加。对于血肿≥5cm的患者，建议积极手术治疗。
方法：这项回顾性队列研究检查了2002年1月至2021年12月在北京大学第三医院接受PGHA阴道分娩的孕妇。进行探索性数据分析以评估平均值，标准偏差(SD)，频率,百分比和百分位数。对连续变量进行独立样本t检验。进行卡方检验以比较分类数据。
结果：共纳入47名PGHA患者，在同一研究期间纳入了94名匹配的对照。与对照组相比,引产(34.0%vs.9.6%,P=0.000）和会阴切开术（66.0％vs.31.9%,P=0.000）在PGHA病例中更常见。产后出血（PPH）的发生率明显较高（53.2%vs.6.4%,PGHA患者的P=0.000）。与血肿<5cm的患者相比，产前贫血的比例(25.8%vs.0.0%,P=0.027）和PPH的发生率（67.7％vs.25.0%,P=0.005）在≥5cm血肿患者中明显更高。相比之下,活跃期明显缩短(3.1±1.9vs.≥5cm血肿患者为5.1±3.0,P=0.031)。会阴疼痛和肿胀有显著差异(31.3%vs.67.7%,P=0.017),外阴血肿（93.8%vs.48.4%,P=0.002）和手术治疗（62.5%vs.96.8%,P=0.002)。≥5cm组中近一半的患者接受了二次缝合(41.9%vs.6.3%,P=0.011)。在超过2小时后检测到PGHA的患者中，体重指数明显较高（24.5±4.3vs.21.4±2.7,P=0.011),和孕期体重增加（14.1±4.3vs.11.4±3.5，P=0.021）明显降低。与无PPH的PGHA患者相比，年龄(31.7±4.4vs.29.4±2.6，P=0.033）和新生儿出生体重（3367±390gvs.3110±419g,P=0.045）在PGHA伴PPH的病例中明显更高，和血小板计数([182±44]×109/Lvs.[219±51]×109/L,P=0.015)显著降低。
结论：行引产和会阴切开术的孕妇PGHA发生率较高。PGHA相关的PPH率显著增加。对于血肿≥5cm的患者，建议积极手术治疗。
