甲氨蝶呤注射联合水囊压迫预防凶险性前置胎盘剖宫产术中出血

The effect of methotrexate intramuscular injection combined with balloon compression for preventing heavy bleeding of pregnant women with placenta previa during cesarean section

目的:研究甲氨蝶呤肌内注射联合水囊压迫止血在预防凶险性前置胎盘剖宫产术中大量出血的效果及对妊娠结局影响。方法:选择2016年9月—2017年9月本院接受剖宫产术的凶险性前置胎盘患者65例作为研究对象,随机数表法分成对照组(n=32)和观察组(n=33)。对照组接受宫体注射卡前列素氨丁三醇注射液,观察组肌内注射甲氨蝶呤配合水囊压迫治疗。对比两组术中出血及月经恢复,妊娠结局、并发症发生率。结果:观察组术中总出血量、输血量、血性恶露时间、月经恢复时间、术后住院时间均低于对照组,不良妊娠结局发生率(3.0%)低于对照组(15.7%)(均P<0.05);术后并发症(感染、恶性呕吐、发热及贫血)的发生率(9.1%)与对照组(21.9%)未见差异(P>0.05)。结论:甲氨蝶呤肌内注射联合水囊压迫可有效减少凶险性前置胎盘患者剖宫产术中出血量,降低不良妊娠结局及并发症发生风险。

Objective:To study the effect of methotrexate intramuscular injection combined with balloon compression for preventing heavy bleeding of pregnant women with placenta previa during cesarean section,and to explore its impact on pregnancy outcomes.Methods:65 women with causative placenta previa who underwent caesarean section were selected as the study subjects from September 2016 to September 2017,and were divided into control group (n=32) and study group (n=33) according to the random number table method.The patients in the control group received carboprost trometamol injection,and the patients in the study group were given intramuscular methotrexate combined with balloon compression.The volume of blood loss during operation,menstruation recovery time,pregnancy outcomes,and complication rate were compared between the two groups.Results:The total volumes of blood loss and blood transfusion,time of bloody lochia,menstruation recovery time,time of postoperative hospital stay,and rate of adverse pregnancy outcomes (3.0% Vs.15.7%) of women in study group were significant lower than those of women in control group (P <0.05).The incidence of postoperative complications (such as infection,vomiting,fever,and anemia) of women in study group was 9.1%,which had no significant different to that (21.9%) of women in control group (P > 0.05).Conclusion:Methotrexate intramuscular injection combined with balloon compression can effectively reduce the volumes of bleeding of women with dangerous placenta previa during cesarean section,and can reduce the rates of adverse pregnancy outcomes and complications.