Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women： The Shanxi Study

Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nulliparous pregnancies unless indicated, to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Comparison between Preoperative and Postoperative Sublingual Misoprostol for Prevention of Postpartum Hemorrhage during Cesarean Section: A Randomized Clinical Trial

Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.

Effect of Hemabate combined with packing therapy on the systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section

Objective:To discuss the effect of Hemabate combined with packing therapy on the systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section. Methods:70 patients with postpartum hemorrhage after placenta previa cesarean section who were treated in Chengdu Women & Children's Central Hospital between January 2014 and February 2017 were collected and then divided into the control group (n=35) who received uterine packing therapy and the observation group (n=35) who received Hemabate combined with packing therapy according to random number table. Serum levels of oxidative stress indexes and stress hormones immediately after operation and 24 h after operation were compared between two groups of patients.Results: Immediately after operation and 24 h after operation, serum oxidative stress indexes ROS and MDA levels of observation group were significantly lower than those of control group while SOD, GSH-px and CAT levels were significantly higher than those of control group, and serum stress hormones NE, E and Cor levels were significantly lower than those of control group.Conclusion: Hemabate combined with packing therapy can effectively reduce systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section, is a more ideal way of the bleeding.

Effect of Predictive Nursing Intervention on Patients with Postpartum Hemorrhage after Cesarean Section

Objective:To study the effect of predictive nursing intervention on patients with postpartum hemorrhage after cesarean section.Methods:84 delivery women who had been hospitalized for cesarean section from July 2016 to July 2017 were recruited.They were divided into experimental and reference groups by random number table method.Each group had 42 cases.Among them,the reference group adopted the routine nursing mode.On this basis,the experimental group adopted the predictive nursing intervention mode.The amount of postpartum hemorrhage and the causes of bleeding in two groups were compared and analyzed.Results:The volume of postpartum hemorrhage in two hours and 24 hours after operation in the experimental group were lesser compared to reference group.Compared with the reference group,the proportion of postpartum hemorrhage causes,such as incision bleeding,uterine atony bleeding,placental bleeding and vascular rupture bleeding was lower in the experimental group.Besides,the delivery women and family members in the experimental group had higher total satisfaction compared to reference group.The difference between two groups was significance(p<0.05).Conclusion:The results showed that predictive nursing intervention model plays an important role in the nursing of postpartum hemorrhage after cesarean section and should be popularized and applied in clinical practice.

Uterine incision dehiscence 3 mo after cesarean section causing massive bleeding:A case report

BACKGROUND The traditional definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period.Here,we report a case of late postpartum hemorrhage that occurred 3 mo after cesarean section and endangered the patient's life.The cause of the case we are reporting was poor incision healing.By reporting this case,we hope to make doctors aware that late postpartum hemorrhage due to poor incision healing may happen as late as 3 mo after cesarean section.CASE SUMMARY A 31-year-old woman complained of acute,severe vaginal bleeding for 1 h;the patient had a history of cesarean section 3 mo prior.After receiving antiinflammatory treatment,fluid supplementation,blood transfusion,oxytocin administration,and hemostatic treatment,the vaginal bleeding ceased,and the patient’s clinical status improved.Unfortunately,she experienced recurrent massive vaginal bleeding,and uterine contractile agents did not decrease the persistent bleeding.To save the patient’s life,she was admitted for emergency laparotomy.At exploratory laparotomy,dehiscence and necrosis of the previous cesarean section scar were noted;the dehiscence penetrated through the entire thickness of the uterine muscle wall and extended to the left uterine artery.Ultimately,we performed a total hysterectomy.CONCLUSION Late postpartum hemorrhage due to poor incision healing after cesarean section may occur in the 3 mo after cesarean section or even later.Therefore,obstetricians-gynecologists should monitor for this potential complication in all patients post–cesarean section.Such hemorrhages can be severe enough to endanger the patient's life.

Oxytocin and Uterine Atony during Cesarean Section

In our medical practice, in particular obstetrics, it is difficult to change certain consolidated dogmas, but the necessity and the current situation of our obstetrical exercise pushed us to find new technical supports, to make the exercise of our specialty as stripped of pitfalls as possible. Our work is summarized in a prospective comparative study, aimed at evaluating the existence or not of a difference between the administration of oxytocin just before the hysterotomy in a cesarean section and its administration after fetal extraction. We used a set of criteria to include patients in our study. This study took place over a period of one year (2020) in the Mother and Child regional center, in Meknes Imperial city, Morocco, involving a total number of 364 patients. With a group A comprising 176 patients 48% (176/364) who received oxytocin just before the hysterotomy and a group B of 188 patients 52% (188/364) who received it classically after fetal extraction. The difference was very significant as detailed in the article. Conclusion: the very convincing results of our study and the difference between the two groups, allowed us to demonstrate the effectiveness of our process and to endorse its use in our routine practice, with the perspective of conducting a prospective randomized study on a larger series.

Oxytocin Abuse and Postpartum Hemorrhage

Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during childbirth and after childbirth by preventing postpartum hemorrhage. But what challenged us to conduct our study is the large and increasing number of surgical operations for postpartum hemorrhage in patients who received oxytocin during labor. We assumed that the generalization use of oxytocin in all patients during labor is probably responsible of this increasing rate of incidents. To verify this assumption, we carried out a prospective randomized comparative study, involving 3990 pregnant patients admitted at the start of labor at term, with no contraindication for giving birth by normal ways, during a period of 10 months (January-October 2022). The patients have been divided into 2 groups. The first group comprises 1991 patients who were placed on admission on a glucose serum infusion with 4 ampoules of a non-anticholinergic musculotropic antispasmodic: “Hydrated phloroglucinol + trimethylphloroglucinol” (Each ampoule contains 40 mg of hydrated phloroglucinol and 0.04 mg of trimethylphloroglucinol) instead of receiving oxytocin during the active phase of their labor and a second group consisting of 1999 patients who received oxytocin during the active phase of their labor. The results were very surprising and contrary to the already consolidated evidence in our specialty. Indeed, the rate of postpartum hemorrhages was 10 patients (0.5%) in the 1st group vs 30 patients (1.5%) in the 2nd group, 9 patients (0.4%) presented fetal heart rate abnormalities in the 1st group vs 90 (4.5%) in the 2nd group, 8 cases (0.4%) of dynamic dystocia in the 1st group vs 132 cases (6.6%) in the 2nd group and 99 caesareans (5%) in the 1st group vs 299 (15%) in the 2nd group. Against all expectations the results were very surprising, with more details in the article.

Balloon Tamponade in the Management of Postpartum Hemorrhage: Three Years of Experience in a Single Center

Introduction: Postpartum hemorrhage (PPH) is one of the leading causes of maternal death in the world and it is reported to occur in 5% - 8% of pregnancies. Objective: This study aimed to present a single centre’s experience in treating PPH by balloon tamponade. Methods: During the time period between January 2013 and March 2016, 50 patients who had undergone balloon tamponade for postpartum hemorrhage in our clinic were evaluated retrospectively. The patients’ age, parity, type of delivery, birth weight, hemoglobin and platelet values, total blood loss from catheter, balloon’s staying time, blood and platelet transfusion status, the presence of placenta anomalies and the Bakri balloon hemostasis success rate were evaluated. Results: During the study period, there were 27,249 deliveries. The frequency of massive postpartum hemorrhage was 0.61% (n = 168). Among the 168 patients with massive postpartum hemorrhage, there were 50 patients in whom the Bakri balloon catheter was used. Bakri balloons were placed via cesarean section incision in 19 patients and via vagina in 31 patients. The mean staying time of Bakri balloon was 18 hours. In 8 patients, balloon tamponade failed. Two patients underwent hysterectomy;other two patients had surgical ligation of the hypogastric artery. Four cases were referred to a tertiary center. Placental invasion abnormalities were observed in five patients. The overall Bakri balloon hemostasis successful rate was found to be as 84% in all cases. Conclusion: Bakri balloon tamponade is an effective, safe and practical approach in the treatment of postpartum hemorrhage.

严重原发性产后出血的影响因素分析

目的探讨导致分娩产妇严重原发性产后出血(PPH)的独立危险因素。方法回顾性选取2016年12月至2021年12月九江市妇幼保健院收治的536例合并PPH的分娩产妇作为研究对象,根据分娩产妇PPH严重程度分为非严重PPH组(n=125)和严重PPH组(n=411)。采用单因素分析和logistic多因素回归分析探讨分娩产妇严重PPH的危险因素。结果非严重PPH组和严重PPH组分别占所有分娩产妇的2.1%和0.49%。单因素分析结果显示,两组产妇的年龄、孕前体重指数(BMI)、分娩次数、剖宫产史、羊水过多、出生体重、多胎妊娠、严重子痫前期、绒毛膜羊膜炎、产程延长、分娩方式和全身麻醉情况比较,差异均有统计学意义(P<0.05)。多因素分析结果显示,剖宫产史(β=0.884,OR=3.15,95%CI=1.02~10.30)、产程延长(β=1.821,OR=3.62,95%CI=3.21~4.03)和紧急剖宫产(β=0.835,OR=4.75,95%CI=1.32~12.96)是严重PPH的独立危险因素(P<0.05)。结论具有剖宫产史、产程延长及接受紧急剖宫产的产妇需引起重视,避免不必要的剖宫产、长时间分娩及紧急剖宫产发生率,减少严重PPH的发生。

改良Hayman缝合术联合卡前列素氨丁三醇治疗剖宫产产后出血及对卵巢恢复的应用效果

目的:探讨改良Hayman缝合术联合卡前列素氨丁三醇治疗剖宫产产后出血及对卵巢恢复的应用效果。方法:选取2019年10月—2022年11月对菏泽市牡丹人民医院剖宫产产后出血患者86例,按随机数字表法分为两组,对照组43例行8字法缝合联合卡前列素氨丁三醇治疗,观察组43例实施改良Hayman缝合术联合卡前列素氨丁三醇治疗,比较两组手术相关指标、疗效、卵巢功能指标、并发症发生情况。结果:观察组住院时间短于对照组,月经复潮时间早于对照组,术中、术后2 h和术后24 h出血量均少于对照组,差异均有统计学意义(P<0.05);观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05);术后,观察组抗米勒管激素(AMH)、雌二醇(E2)均高于对照组,促黄体生成素(LH)、促卵泡生成素(FSH)均低于对照组,差异均有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论:将改良Hayman缝合术联合卡前列素氨丁三醇应用到剖宫产产后出血治疗中,可有效提高手术效率,降低术中及术后出血量,改善卵巢功能,且并发症发生率低。

北京市区域严重产后出血分级诊疗及转诊管理的现况调查

目的:探讨转诊中心与非转诊中心严重产后出血(SPPH)的救治现况,为区域内SPPH的预防和处理提供改进策略。方法:回顾性分析2021年1月至2023年6月北京市两区SPPH(产后出血量≥1500 ml或输血制品≥1000 ml)病例的临床资料,共纳入SPPH 201例,根据其是否为市级转诊中心分为转诊中心组(125例)和非转诊中心组(76例)。比较两组间的临床特征。进一步分层分析,采用Logistic回归模型分析大量产后出血,即产后出血量≥4000 ml,和(或)输注悬浮红细胞(RBC)>10 U和(或)输注血浆>1000 ml的危险因素。结果:对两组SPPH病例分析,转诊中心组较非转诊中心组患者的年龄大,分娩孕周小,伴有孕期产后出血高危因素的比例高,差异有统计学意义(P<0.05);转诊中心组SPPH的首要原因为胎盘因素,而非转诊中心组的首要因素为子宫收缩乏力,差异有统计学意义(P<0.05);非转诊中心组在剖宫产术中出血量高,采用B-Lynch缝合/血管缝扎的比例低,宫腔填塞比例高(P<0.05);非转诊中心组血浆输注量、重返手术室、剖腹探查、各种产后出血并发症的发生率均显著高于转诊中心组(P<0.05);非转诊中心组大量产后出血病例数显著多于转诊中心组(P<0.05)。在大量产后出血病例中,转诊中心组具有孕期产后出血高危因素者多于非转诊中心组(71.4%vs.33.3%,P<0.05),转诊中心组胎盘因素是主要出血原因(57.1%),非转诊中心组子宫收缩乏力和胎盘因素是主要出血原因(42.9%,28.6%)。多因素Logistic回归分析发现,非转诊中心分娩(aOR 3.47,95%CI 1.40~9.18)、多次宫腔操作史(aOR 12.63,95%CI 1.24~131.30)是大量产后出血的高危因素。结论:区域内高危孕产妇转诊管理效果较好,加强非转诊助产机构的高危因素识别、手术缝合技术和SPPH综合管理培训,预防SPPH、大量产后出血和输血的发生。

Analysis of risk factors related to severe postpartum hemorrhage of twin pregnancies delivered by cesarean section

Objective:To investigate the risk factors of severe postpartum hemorrhage(PPH)in cesarean section of twin pregnancy,and to provide clinical basis for pregnancy management and perioperative obstetric management of twin pregnancy.Methods:The clinical data of 631 twin pregnancies with gestational age
28 weeks delivered by cesarean section at Peking University People's Hospital(PKUPH)from January 2004 to January 2017 were retrospectively analyzed.Methods of conception,the combined weight of twins,serum albumin level before cesarean section,operation time and other factors on the amount of blood loss during cesarean section were analyzed.Results:The proportion of severe PPH was significantly higher in in vitro fertilization-embryo transfer(IVF-ET)group,the combined weight of twins>6000g group,serum albumin before cesarean section<30 g/dl group than in the natural pregnancy group,4000–6000g group,<4000g group and serum albumin
30 g/dl group respectively(P<0.05).The proportion of severe PPH in the elective surgery group of twin pregnancy was higher than that in the emergency surgery group,but the difference was not statistically significant(P>0.05).Moreover,according to the surgical indications,the emergency surgery group was divided into premature rupture of membranes(PROM),labor,fetal distress and others groups,no significant difference were detected among these groups(P>0.05).Conclusion:IVF-ET,the combined weight of twins,serum albumin before operation were significantly correlated with severe PPH of twin pregnancies delivered by cesarean section,revealing that it is necessary to strengthen pregnancy management of twin pregnancy.

缩宫素联合卡贝缩宫素预防剖宫产术中子宫收缩乏力引起产后出血的临床效果

目的 探究缩宫素联合卡贝缩宫素预防剖宫产术中子宫收缩乏力引起产后出血的临床效果。方法 选取在宁阳县妇幼保健院2016年1月至2022年12月行剖宫产术的98例产妇,按照随机数字表法分为两组。观察组(49例)予以缩宫素联合卡贝缩宫素,对照组(49例)予以缩宫素,比较两组产后出血量、宫缩情况、不良反应发生情况。结果 观察组产后2、24 h出血量均少于对照组(P <0.05);观察组宫缩良好率高于对照组(P <0.05);观察组不良反应总发生率低于对照组(P <0.05)。结论 缩宫素联合卡贝缩宫素在产后出血中的应用效果较好,能够减少产后出血量,降低不良反应发生率。

新型子宫下段平行垂直压迫缝合术联合麦角新碱治疗前置胎盘剖宫产产后出血的效果

目的 分析新型子宫下段平行垂直压迫缝合术联合麦角新碱治疗前置胎盘剖宫产产后出血的效果。方法 选择我院2017年1月至2021年12月收治的40例前置胎盘剖宫产产后出血患者作为研究对象,以随机法将其分为常规组(20例,新型子宫下段平行垂直压迫缝合术治疗)和观察组(20例,新型子宫下段平行垂直压迫缝合术联合麦角新碱治疗)。比较两组的治疗效果。结果 观察组的红细胞悬液用量、血浆用量、止血时间、住院时长及治疗后2、24 h的出血量均低于常规组(P<0.05)。观察组的不良事件总发生率低于常规组(P<0.05)。治疗后,观察组的活性氧(ROS)、丙二醛(MDA)及D-二聚体(D-D)水平显著低于常规组,超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)及过氧化氢酶(CAT)水平显著高于常规组,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著短于常规组(P<0.05)。治疗后,观察组的子宫螺旋动脉收缩期峰值流速(PSV)、搏动指数(PI)均显著高于常规组,阻力指数(RI)显著低于常规组(P<0.05)。结论 新型子宫下段平行垂直压迫缝合术联合麦角新碱治疗前置胎盘剖宫产产后出血可取得理想的效果。

子宫背带式缝合术在剖宫产术后出血治疗中的应用效果

目的探讨子宫背带式缝合术在剖宫产术后出血治疗中的应用效果。方法选取本院进行剖宫产并发生产后出血的100例产妇为研究对象,采用随机数字表法分为两组,各50例。对照组采用宫腔纱布填塞术,试验组采用子宫背带式缝合术,比较两组的治疗效果、手术相关指标、凝血功能及并发症发生率。结果,试验组治疗总有效率为94.0%,高于对照组的74.0%(P<0.05);试验组术后2h、术后24h出血量少于对照组,血红蛋白水平高于对照组(P<0.05);试验组凝血酶时间、活化部分凝血活酶时间短于对照组,纤维蛋白原水平高于对照组(P<0.05);试验组并发症发生率低于对照组(P<0.05)。结论子宫背带式缝合术在治疗剖宫产术后出血方面具有确切疗效,能减少产妇出血量,提高凝血功能,降低剖宫产术后并发症发生率,值得临床推广与应用。

标准化护理剖宫产术后患者效果研究

目的:分析剖宫产术后标准化护理效果。方法:本研究选取2022年1月至2023年1月在甘肃省舟曲县人民医院进行剖宫产手术的120例产妇作为样本研究对象,随机分为对照组与观察组,对照组接受常规护理,观察组接受标准化护理。分析比较两组产妇护理后产后出血量、并发症发生率及不良情绪评分。结果:观察组产后出血量较对照组更少,P<0.05;观察组并发症得到显著控制,P<0.05;观察组产妇不良情绪改善更为显著,P<0.05。结论:剖宫产术后标准化护理对产妇产后出血风险有所抑制,并且减少了产妇并发症的发生风险,有利于改善产妇不良情绪。

预防性使用氨甲环酸减少高危妊娠剖宫产出血的临床观察

目的:观察预防性使用氨甲环酸减少高危妊娠剖宫产出血的临床效果。方法:选取2021年8月—2023年12月萍乡市妇幼保健院收治的80例高危妊娠孕妇,均经剖宫产终止妊娠,依照随机数字表法分为观察组(n=40)、对照组(n=40)。术前20 min观察组将1.0 g氨甲环酸注射液加入100 mL 0.9%氯化钠注射液中静滴,对照组静滴复方氯化钠注射液120 mL,断脐后均宫体注射缩宫素注射液10 U。比较两组围手术期相关参数、产后出血与凝血功能[凝血酶原时间(PT)、D-二聚体(D-D)等]差异,对比两组新生儿不良事件、不良反应发生情况。结果:观察组住院时间、血性恶露持续时间均短于对照组,缩宫素使用量少于对照组,观察组宫缩持续时间较对照组延长,而子宫底下降速度大于对照组(P<0.05),两组手术时间差异无统计学意义(P>0.05);观察组产时、术后2 h、术后24 h的出血量及产后出血率均低于对照组(P<0.05);两组术后24 h纤维蛋白原(FIB)、纤维蛋白原降解产物(FDP)均高于术前,活化部分凝血活酶时间(APTT)、PT均短于术前,D-D均低于术前,且观察组术后24 h FIB、FDP均高于对照组,APTT、PT均短于对照组,D-D低于对照组(P<0.05);两组新生儿窒息发生率、不良反应发生率差异均无统计学意义(P>0.05)。结论:对于高危妊娠剖宫产产妇,在术前预防性使用氨甲环酸可促进产后恢复,明显减少出血,调节凝血功能,而不增加新生儿不良事件及不良反应发生风险。

卡前列素氨丁三醇联合缩宫素预防瘢痕子宫再次剖宫产产妇产后出血的价值

目的:分析卡前列素氨丁三醇联合缩宫素预防瘢痕子宫再次剖宫产产妇产后出血的价值。方法:选择2022年10月—2023年9月建瓯市妇幼保健院收治的60例瘢痕子宫再次剖宫产产妇作为研究对象,按随机数表法分为观察组和对照组,各30例。对照组给予缩宫素治疗,观察组在对照组基础上联合卡前列素氨丁三醇治疗。比较两组不同时间出血量、止血时间、子宫收缩持续情况、凝血功能指标及不良反应。结果:观察组术中及产后2 h、24 h出血量少于对照组,止血时间较对照组短,子宫收缩时间较对照组长,子宫底下降速度较对照组快,治疗后凝血酶原时间(PT)、凝活化部分凝血酶时间(APTT)短于对照组,纤维蛋白原(FIB)、D-二聚体(D-D)水平高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:卡前列素丁三醇联合缩宫素预防瘢痕子宫再次剖宫产产妇产后出血效果良好,能减少产后出血量,缩短止血时间,改善凝血指标和子宫收缩情况,安全可靠。

子宫背带式缝合术对剖宫产产后出血产妇术中及产后出血量的影响研究

目的探讨子宫背带式缝合术对剖宫产产后出血产妇术中及产后出血量的影响。方法30例行剖宫产分娩且伴有产后出血的产妇,以随机信封法分为对照组与观察组,每组15例。对照组采用子宫腔纱布填塞术治疗,观察组采用子宫背带式缝合术治疗。比较两组治疗效果、临床指标、生活质量及并发症发生情况。结果观察组治疗总有效率93.33%高于对照组的60.00%(P<0.05)。观察组手术用时(53.61±8.56)min、术中出血量(571.26±60.19)ml、术后24 h出血量(221.32±25.74)ml、住院时间(6.05±1.21)d均优于对照组的(62.17±10.25)min、(681.37±57.84)ml、(251.58±23.78)ml、(7.89±1.79)d(P<0.05)。观察组躯体功能、认知功能、情绪功能、角色功能、社会功能评分均高于对照组(P<0.05)。观察组并发症发生率13.33%低于对照组的46.67%(P<0.05)。结论以子宫背带式缝合术治疗剖宫产产后出血产妇,可减少患者术中及术后出血量,缩短手术用时及住院时间,同时还具有较高治疗安全性,利于促进患者术后恢复,临床借鉴价值较高,适宜推广借鉴。

子宫动脉上行支结扎联合产后止血球囊治疗中央性前置胎盘的临床效果

目的探讨剖宫产术中采用双侧子宫动脉上行支结扎术联合宫腔填塞产后止血球囊对中央性前置胎盘所致产后出血的临床效果和影响。方法选择宁德市闽东医院2020年1月—2022年12月收治的80例中央性前置胎盘所致产后出血患者为研究对象。按治疗方式不同分为观察组(40例)和对照组(40例);对照组在剖宫产术中联合使用子宫压迫缝合及宫腔填塞纱布条传统止血技术;观察组采用双侧子宫动脉上行支结扎术联合宫腔填塞产后止血球囊的联合止血技术。比较2组治疗效果。结果观察组的止血时间、24 h出血量、术中出血量、手术时间及输血率均优于对照组,差异有统计学意义(P<0.05)。治疗后,观察组的血红蛋白水平为(98.82±3.24)g/L、血细胞比容为(32.57±2.08)%,高于对照组的(95.65±2.77)g/L、(25.65±1.58)%,差异有统计学意义(P<0.05)。2组产褥感染率、子宫切除率、子宫动脉栓塞发生率及入住ICU率比较,差异无统计学意义(P>0.05)。治疗后,观察组的凝血酶时间(thrombin time,TT)长于对照组,凝血酶原时间(prothrombin time,PT)、D-二聚体(D-Dimer,D-D)、纤维蛋白原(fibrinogen,FIB)水平均低于对照组,差异有统计学意义(P<0.05)。结论采用双侧子宫动脉上行支结扎术联合宫腔填塞产后止血球囊的联合止血技术对中央性前置胎盘所致产后出血的临床治疗效果显著,能缩短手术时间,减少出血量,且与传统治疗方案相比并不会增加产褥感染率、子宫切除率的风险。此文的研究结果为中央性前置胎盘治疗方案的后期标准制定提供了借鉴内容。