Brandt法牵引脐带配合脐静脉注射催产素预防胎盘滞留及产后出血的临床应用

目的:探讨Brandt法牵引脐带配合脐静脉注射催产素预防胎盘滞留及产后出血的临床效果。方法:将400例阴道分娩产妇随机分治疗组及对照组。治疗组200例产妇在胎儿娩出后,迅速在阴道口处钳夹脐带并断脐,于脐静脉处快速注射催产素20U加生理盐水20ml,然后应用Brandt法牵引脐带(即一手持续地牵引脐带,另一手在耻骨上用力将子宫保持在位)。对照组200例,胎儿娩出后立即母体肌注或静滴催产素20U。然后记录第三产程的时间、出血量、产后2小时出血量及有无胎盘滞留、宫腔操作等进行对比研究。结果:治疗组第三产程时间<5分钟,与对照组比较差异有显著性。第三产程和产后2小时出血量治疗组比对照组少,比较差异有显著性。胎盘滞留行人工剥离胎盘术,治疗组0例,对照组16例。结论:应用Brandt法牵引脐带配合脐静脉内注射生理盐水加催产素,可以缩短第三产程,预防或减少产后出血,减少胎盘滞留率、减少手取胎盘及刮宫的几率,具有重要的临床意义。同时本方案操作简单易行,安全性高,费用低。

Objective:To discuss clinical effects of Brandt method for umbilical cord traction and umbilical vein injection of oxytocin to prevent placental retention and postpartum hemorrhage.Method:Divide 400 puerperae of vaginal delivery randomly into the treatment group and the control group.Treatment group:for 200 puerperae,ligature and cut the umbilical cord in the vaginal orifice rapidly,inject 20U oxytocin and 20ml normal saline in umbilical vein fast,and then use Brandt method for umbilical cord traction(one hand performs continuous umbilical cord traction,while the other hand forcibly holds the uterus in the pubis).Control group:for 200 puerperae,inject 20U oxytocin in muscle or umbilical vein immediately after baby delivery.Record time of the third stage of labor,amount of bleeding,amount of bleeding 2h after delivery,condition of placental retention,and intrauterine operation,etc for contrast studies.Result:The time of the third stage of labor of the treatment grouP<5min,with significant difference compared with the control group.The third stage of labor and amount of bleeding 2h after delivery of the treatment group were smaller than those of the control group,which were of significant difference.0 case in the treatment group and 16 cases in the control group adopted manual removal of placenta.Conclusion:Application of Brandt method for umbilical cord traction and umbilical vein injection of normal saline and oxytocin can shorten the third stage of labor,prevent or reduce bleeding after delivery,decrease placental retention rate,and reduce rates of manual removal of placenta and uterine curettage,which is of great clinical significance.Besides,this scheme boasts the advantages of simple operation,high safety,low cost,and easy promotion.