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 tim...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.展开更多
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 ...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.展开更多
目的观察三种宫缩药物(卡前列甲酯栓,米索前列醇,缩宫素)预防高危产妇剖宫产术中及术后出血的疗效。方法选择有产后出血倾向的高危孕妇240例,按随机数字表法分为3组:卡前列甲酯栓组(n=80),娩出胎儿后立即缩宫素20 I U静脉滴注+卡前列甲...目的观察三种宫缩药物(卡前列甲酯栓,米索前列醇,缩宫素)预防高危产妇剖宫产术中及术后出血的疗效。方法选择有产后出血倾向的高危孕妇240例,按随机数字表法分为3组:卡前列甲酯栓组(n=80),娩出胎儿后立即缩宫素20 I U静脉滴注+卡前列甲酯栓1 mg舌下含服;米索前列醇组(n=80),胎儿娩出后缩宫素20 I U静脉滴注+缩宫素20 I U宫体注射+米索前列醇600μg塞肛;缩宫素组(n=80),胎儿娩出后缩宫素20 I U静脉滴注+缩宫素20 I U宫体注射。计算三组术中出血量及产后24 h出血量,比较3种宫缩剂的疗效。结果缩宫素组产后24 h出血量、产后出血发生率及产后24 h血红蛋白平均下降值明显高于卡前列甲酯栓组和米索前列醇组(P<0.05),差异有统计学意义。卡前列甲酯栓组与米索前列醇组经比较,差异无统计学意义(P>0.05)。结论卡前列甲酯栓、米索前列醇用于有产后出血倾向的产妇,可明显减少剖宫产术中及术后出血量,其效果优于缩宫素,且具有安全、高效、迅速、价廉、方便等优点。展开更多
目的:观察益母草注射液联合卡前列素氨丁三醇用于预防剖宫产产后出血的疗效和安全性。方法:177例拟行剖宫产妊娠期妇女随机分为对照组(87例)和观察组(90例)。两组妊娠期妇女均行剖宫产术,对照组妊娠期妇女于胎儿娩出后立即向切口上方的...目的:观察益母草注射液联合卡前列素氨丁三醇用于预防剖宫产产后出血的疗效和安全性。方法:177例拟行剖宫产妊娠期妇女随机分为对照组(87例)和观察组(90例)。两组妊娠期妇女均行剖宫产术,对照组妊娠期妇女于胎儿娩出后立即向切口上方的子宫肌壁注射缩宫素20 U,后给予20 U缩宫素加入0.9%氯化钠注射液250 m L中,静脉滴注,术后4 h肌内注射缩宫素10U,后每12 h肌内注射1次,连用3 d;观察组妊娠期妇女于胎儿娩出后立即向子宫切口处肌内注射益母草注射液2 m L,卡前列素氨丁三醇注射液1 m L,术后4 h再次肌内注射益母草注射液2 m L,卡前列素氨丁三醇注射液1 m L,后每12 h肌内注射益母草注射液2 m L,连用3 d。观察两组妊娠期妇女的临床疗效,术中、术后2 h、术后24 h出血量,术前及术后24 h血红蛋白(Hb)水平,产后3、7 d宫底高度及不良反应发生情况。结果:观察组妊娠期妇女总有效率显著高于对照组,术中、术后2 h、术后24 h出血量及产后3、7 d宫底高度均显著低于对照组,差异均有统计学意义(P<0.05)。术前,两组妊娠期妇女Hb水平比较,差异均无统计学意义(P>0.05)。术后24 h,对照组妊娠期妇女Hb水平均显著低于同组术前及观察组,差异均有统计学意义(P<0.05);观察组妊娠期妇女术前、术后24 h Hb水平比较,差异均无统计学意义(P>0.05)。两组妊娠期妇女不良反应发生率比较,差异无统计学意义(P>0.05)。结论:益母草注射液联合卡前列素氨丁三醇用于妊娠期妇女剖宫产产后出血的疗效显著,可明显降低术中及术后出血量,加快子宫复旧,且未增加不良反应的发生。展开更多
文摘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.
基金Supported by National Natural Science Foundation of China,No.81202048.
文摘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.
文摘目的观察三种宫缩药物(卡前列甲酯栓,米索前列醇,缩宫素)预防高危产妇剖宫产术中及术后出血的疗效。方法选择有产后出血倾向的高危孕妇240例,按随机数字表法分为3组:卡前列甲酯栓组(n=80),娩出胎儿后立即缩宫素20 I U静脉滴注+卡前列甲酯栓1 mg舌下含服;米索前列醇组(n=80),胎儿娩出后缩宫素20 I U静脉滴注+缩宫素20 I U宫体注射+米索前列醇600μg塞肛;缩宫素组(n=80),胎儿娩出后缩宫素20 I U静脉滴注+缩宫素20 I U宫体注射。计算三组术中出血量及产后24 h出血量,比较3种宫缩剂的疗效。结果缩宫素组产后24 h出血量、产后出血发生率及产后24 h血红蛋白平均下降值明显高于卡前列甲酯栓组和米索前列醇组(P<0.05),差异有统计学意义。卡前列甲酯栓组与米索前列醇组经比较,差异无统计学意义(P>0.05)。结论卡前列甲酯栓、米索前列醇用于有产后出血倾向的产妇,可明显减少剖宫产术中及术后出血量,其效果优于缩宫素,且具有安全、高效、迅速、价廉、方便等优点。
文摘目的:观察益母草注射液联合卡前列素氨丁三醇用于预防剖宫产产后出血的疗效和安全性。方法:177例拟行剖宫产妊娠期妇女随机分为对照组(87例)和观察组(90例)。两组妊娠期妇女均行剖宫产术,对照组妊娠期妇女于胎儿娩出后立即向切口上方的子宫肌壁注射缩宫素20 U,后给予20 U缩宫素加入0.9%氯化钠注射液250 m L中,静脉滴注,术后4 h肌内注射缩宫素10U,后每12 h肌内注射1次,连用3 d;观察组妊娠期妇女于胎儿娩出后立即向子宫切口处肌内注射益母草注射液2 m L,卡前列素氨丁三醇注射液1 m L,术后4 h再次肌内注射益母草注射液2 m L,卡前列素氨丁三醇注射液1 m L,后每12 h肌内注射益母草注射液2 m L,连用3 d。观察两组妊娠期妇女的临床疗效,术中、术后2 h、术后24 h出血量,术前及术后24 h血红蛋白(Hb)水平,产后3、7 d宫底高度及不良反应发生情况。结果:观察组妊娠期妇女总有效率显著高于对照组,术中、术后2 h、术后24 h出血量及产后3、7 d宫底高度均显著低于对照组,差异均有统计学意义(P<0.05)。术前,两组妊娠期妇女Hb水平比较,差异均无统计学意义(P>0.05)。术后24 h,对照组妊娠期妇女Hb水平均显著低于同组术前及观察组,差异均有统计学意义(P<0.05);观察组妊娠期妇女术前、术后24 h Hb水平比较,差异均无统计学意义(P>0.05)。两组妊娠期妇女不良反应发生率比较,差异无统计学意义(P>0.05)。结论:益母草注射液联合卡前列素氨丁三醇用于妊娠期妇女剖宫产产后出血的疗效显著,可明显降低术中及术后出血量,加快子宫复旧,且未增加不良反应的发生。
