产后出血的研究进展

Research Progress of Postpartum Hemorrhage

产后出血(PPH)是导致孕产妇患病及死亡的常见原因之一,目前多数定义为阴道分娩后24 h累计失血量≥500 mL,剖宫产术后累计失血量≥1 000 mL。但PPH的诊断不仅要以失血量为依据,也要重视血流动力学的改变。缩宫素作为预防和治疗PPH的一线药物已成为共识,卡贝缩宫素、卡前列素氨丁三醇和米索前列醇等亦可应用。具有PPH高危因素的孕妇,剖宫产术中除预防使用缩宫素之外,还可考虑静脉使用氨甲环酸以减少出血。尚无证据表明哪一种手术治疗方式更佳,常需根据实际情况进行选择。发生PPH时,凝血功能异常是大量输血和子宫切除的预测指标,当出血难以控制时,早期输注纤维蛋白原是安全和有效的。早期识别,综合处理,建立团队,总结和模拟演练都是PPH处置不可或缺的环节。

Postpartum hemorrhage(PPH)is one of the top reasons of maternal morbidity and death.Estimated blood loss more than 500 mL after vaginal birth and more than 1 000 mL after cesarean birth are currently used to define postpartum hemorrhage.The diagnosis not only depend on the blood loss volume,but also the change of patient's hemodynamics.Oxytocin,the gold standard for PPH prevention and treatment is accepted by majority of obstetrician,and carbetocin,carboprost tromethamine,misoprostol are also can be used.When the patient has high risk of PPH,in addition to the prevention of oxytocin during cesarean section,intrarenous tranexamic acid may also be considered to reduce bleeding.Because there is no evidence to support the best way among current operation methods,we should choose the pattern by practical conditions.Once PPH occurs,coagulopathy is the forecasting indicators for massive transfusion and hysterectomy,and an early fibrinogen concentrate infusion in uncontrolled active PPH is effective and safe.Discernment earlier,disposal comprehensively,estabilish the emergency management team,debriefs and staff training ars indispensable procedure in PPH management.