第三产程中不同处理方法的临床效果比较

Comparison of Three and Types of Management in the Third Stage of Labor

目的比较第三产程中预防产后出血的三种措施对产后出血量、产后是否需要宫腔操作的影响。方法回顾性分析2016年5月—2017年12月期间,在我院采用阴道分娩并行人工剥离胎盘术的421名产妇的产后出血量及产后是否进行宫腔操作。将421例产妇分为三组,三组均在胎儿前肩娩出后即予催产素20 U静脉滴注,A1组(163例)采用传统的娩胎盘法,清理呼吸道后断脐(时间<1 min),胎儿娩出后15 min胎盘未娩出,予催产素20 U加生理盐水20 m L脐静脉注射,30 min胎盘仍未娩出即行人工剥离胎盘术。A2组(180例)当胎儿娩出后,等待1 min予断脐,实行控制性脐带牵引法牵拉脐带,15 min胎盘仍未娩出即行人工剥离胎盘术。A3组(78例)当胎儿娩出后,等待1 min予断脐,实行控制性脐带牵引法牵拉脐带,30 min胎盘仍未娩出即行人工剥离胎盘术。然后准确记录三组病例的产后2 h出血量、是否需要宫腔操作,进行对比研究。结果产后2 h出血量方差分析结果 F=3. 707,三组出血量存在统计学差异,两两比较显示A2组出血量低于A1组(P <0. 05),A3组出血量和其他两组之间没有差别(P>0. 05)。需要人工剥离胎盘术的比例,A1组2. 7%,A2组5. 0%,A3组1. 4%,三组的人工胎盘剥离率之间存在显著差异(x^2=82. 71,P <0. 001); A3组的人工剥离处理率明显低于前两组。结论积极正确处理第三产程,能有效预防产后出血,但过早行人工剥离胎盘术,必将增加侵入性操作及感染风险,应实行控制性脐带牵引法牵拉脐带至30 min,胎盘仍未娩出才行人工剥离胎盘术为目前较合适的方法,催产素脐静脉注射处理胎盘滞留效果不佳,不应再作推广使用。

Ojbective To compare postpartum hemorrhage and rate of manual removal of placenta among three types of management in the third stage of labor.Methods Retrospective analysis of the postpartum hemorrhage of421women who underwent vaginal delivery and manual resection of placenta in our hospital from May2016to December2017,and whether or not uterine operation was performed after delivery.421cases of women were randomly divided into three groups.The three groups were given oxytocin20U intravenously after the delivery of the anterior shoulder of the fetus.The A1group(163cases)used the traditional placenta method to clear the airway and cut the umbilicus(time<1min).),the placenta was not delivered15minutes after the delivery of the fetus,oxytocin20U plus saline20ml umbilical vein injection,30min placenta still not delivered immediately after the artificial peeling placenta.In group A2(180cases),after the fetus was delivered,wait for1min to break the umbilicus,and carry out controlled umbilical cord traction to pull the umbilical cord.The15min placenta was still not delivered and the artificially stripped placenta was performed.In group A3(78cases),after the fetus was delivered,wait for1min to break the umbilicus,and control the umbilical cord traction method to pull the umbilical cord.The30-minute placenta was still not delivered and the artificially stripped placenta was performed.Then accurately recorded the postpartum2h bleeding volume of the three groups of patients,whether the need for intrauterine operation,a comparative study.Results The results of variance analysis of2h postpartum hemorrhage were F=3.707.There was statistical difference between the three groups.The difference between the two groups showed that the A2group had lower blood loss than the A1group(P<0.05).There was no bleeding between the A3group and the other two groups.Difference(P>0.05).The proportion of patients requiring manual resection of placenta was2.7%in group A1,5.0%in group A2,and1.4%in group A3.There was a significant difference in the rate of artificial placenta exfoliation between the three groups(2=82.71,P<0.001);treatment of group A3The rate of manual peeling treatment was significantly lower than that of the first two groups.Conclusion Actively and correctly treating the third stage of labor can effectively prevent postpartum hemorrhage,but premature manual stripping of the placenta will increase the risk of invasive operation and infection.The umbilical cord should be pulled by the controlled umbilical cord traction method for30minutes,and the placenta is still not delivered.Manual stripping of placenta is currently the most suitable method.Oxytocin intravenous injection for the treatment of placenta retention is not good and should not be used for promotion.