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.

Observation on the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia

Objective:To explore the effect of carbetocin in preventing postpartum hemorrhage caused by uterine inertia.Methods: A total of 256 puerpera with single full-term delivery who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the vaginal delivery group and cesarean section group with 128 cases in each group according to the delivery ways. According to the medication, each group was divided into the carbetocin group and oxytocin group with 64 cases in each group. After fetus delivery, the puerpera in the carbetocin group were given intravenous injection of carbetocin (100μg), while the puerpera in the oxytocin group were given intravenous injection of oxytocin (10 U)+0.9% NaCl (500 mL) for 2 h. The amount of bleeding at delivery, 2 h and 24 h after delivery in each group was observed. A volume of 5 mL elbow venous blood before delivery and 24 h after delivery was extracted. The automatic blood cell analyzer was used to detect the decreased value of 24 h hemoglobin in each group. The coagulation detector was used to detect PT, APTT, and FIB before delivery and 24 h after delivery. The blood pressure and heart rate before and after medication in each group were observed.Results: The amount of bleeding at delivery, 2 h and 24 h after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The decreased value of 24 h hemoglobin after delivery in the carbetocin group was signiifcantly less than that in the oxytocin group (P<0.05). The indicators of coagulation function 24 h after delivery in each group were not signiifcantly changed (P>0.05). The heart rate and blood pressure after medication in each group were not significantly changed when compared with before medication (P>0.05).Conclusions:Carbetocin can effectively prevent the postpartum hemorrhage caused by uterine inertia, and is safe and effective in application of vaginal delivery and cesarean section;therefore, it deserves to be widely recommended in the clinic.

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.

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.

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.

Correlation of large conductance Ca2+ activated K+ channelα andβ subunit expression in uterine smooth muscle with the postpartum hemorrhage induced by uterine inertia

Objective:To study the correlation of large conductance Ca2+ activated K+ channel (BKCa)α andβ subunit expression in uterine smooth muscle with the postpartum hemorrhage induced by uterine inertia.Methods: The puerperae who underwent cesarean section and had postpartum hemorrhage induced by uterine inertia in Panzhihua Women and Children Health Hospital between March 2015 and May 2017 were selected as the hemorrhage group of the study, and the puerperae who underwent cesarean section and were without postpartum hemorrhage in Panzhihua Women and Children Health Hospital during the same period were selected as the control group. Proper amount of uterine muscle tissue was collected during the cesarean section to measure the expression of BKCaα andβ subunits and the levels of contraction-related proteins in uterine muscle as well as the contraction characteristic parameters of the uterine muscle.Results: The mRNA expression and protein expression of BKCaα andβ subunits in uterine muscle tissue of hemorrhage group were significantly higher than those of control group;the contraction amplitude, contraction frequency and contraction activity of uterine muscle tissue as well as the OTR, COX2, CX43 and HSP27 levels in uterine muscle tissue of hemorrhage group were significantly lower than those of control group;the BKCaα andβ subunit expression in uterine muscle tissue of hemorrhage group were negatively correlated with the contraction amplitude, contraction frequency and contraction activity as well as the OTR, COX2, CX43 and HSP27 levels.Conclusion: The high expression of BKCa in uterine smooth muscle can reduce the uterine muscle contractility and decrease the levels of contraction-related proteins, and it is closely related to the occurrence of postpartum hemorrhage induced by uterine inertia.

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.

Endometrial Necrosis Following B-Lynch Suture for Uterine Atony

B-Lynch compression suturing was performed on a 30-year old primipara during emergency Cesarean section (CS). After CS, she developed a low-grade fever, a subinvolution and tenderness of the uterus, and a pronounced increase in the inflammatory markers. Antibiotics were altered according to bacterial cultures and drug sensitivity testing of the cervix. By 10 days postpartum, a diagnostic curettage was performed and released a foul-smelling liquid matter due to the substantial amount of heterogeneous material with gaseous echoes showed via ultrasonography. The inflammatory markers gradually returned to normal by 9 days post curettage. At 12-day post curettage, a foul-smelling purulent tissue was extruded spontaneously via the vagina and proved to be necrotic tissue on pathologic examination. Eighteen months after childbirth, the patient had not experienced a menstrual period or subsequent pregnancy and a small uterus without any evidence of an endometrium showed by ultrasonography.

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.

基于循证案例分析的优质护理对宫缩乏力性产后出血的护理效果

目的:探讨基于循证案例分析的优质护理对宫缩乏力性产后出血患者的护理效果。方法:选取104例宫缩乏力性产后出血患者,按照护理方式不同将患者分为对照组和观察组,两组各52例。对照组给予常规护理;观察组在常规护理基础上使用基于循证案例分析的优质护理,对比两组患者的出血情况、临床疗效、凝血及纤溶功能指标水平、并发症发生情况、生活质量。结果:观察组患者产后0.5、2、12及24 h出血量均少于对照组,止血耗时短于对照组(P<0.05);干预后,观察组患者活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)水平均低于对照组,纤维蛋白原(FIB)水平高于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05);观察组患者SF-36量表各维度评分均高于对照组(P<0.05)。结论:基于循证案例分析的优质护理可有效降低宫缩乏力性产后出血患者的出血量,缩短止血时间,改善凝血及纤溶功能,减少并发症发生率,提高生活质量。

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。

剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性分析

目的 研究剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性。方法 选择剖宫产术后再次妊娠行阴道试产的66例产妇作为瘢痕组,另选择同期非瘢痕子宫妊娠行阴道试产的66例产妇作为非瘢痕组。比较两组阴道试产结果,阴道试产成功产妇产程,产后出血量、住院时间及产后胎盘残留发生情况,不良妊娠结局发生情况,新生儿Apgar评分。结果 瘢痕组与非瘢痕组的阴道试产成功率(78.79%VS 84.85%)、转剖宫产率(21.21%VS 15.15%)比较,差异无统计学意义(P>0.05)。瘢痕组阴道试产成功产妇第一、二、三产程及总产程时间与非瘢痕组比较,差异无统计学意义(P>0.05)。瘢痕组产后出血量(210.28±56.36)ml、住院时间(3.69±1.62)d和产后胎盘残留发生率12.12%与非瘢痕组的(205.17±49.69)ml、(3.71±1.59)d、7.58%(5/66)比较,差异无统计学意义(P>0.05)。瘢痕组不良妊娠结局发生率(13.64%)与非瘢痕组(10.61%)比较,差异无统计学意义(P>0.05)。瘢痕组出生后1、5、10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿预后良好,无转入新生儿科记录。结论 剖宫产术后瘢痕子宫再次妊娠产妇的阴道试产成功率与非瘢痕子宫妊娠产妇基本一致,且未增加产程时间及产后出血量,不良妊娠结局发生率无明显升高,临床应用安全性可靠,证实该类产妇经阴道分娩的可行性较强,对提升阴道分娩率及降低剖宫产率具有重要应用价值。

卡前列素氨丁三醇与麦角新碱预防剖宫产产妇出血及对子宫复旧的作用

目的观察卡前列素氨丁三醇与麦角新碱预防剖宫产产妇出血及对子宫复旧的作用。方法该项目为回顾性研究,选取2019年3月至2024年1月在合肥市第一人民医院行剖宫产术的产妇118例,根据产后药物干预方案分为A组(n=48,采用麦角新碱治疗)、B组(n=33,采用卡前列素氨丁三醇治疗)和C组(n=37,采用卡前列素氨丁三醇联合麦角新碱治疗)。收集3组患者临床资料,比较3组患者产后出血量、恶露持续时间、住院时间、产后出血发生率及子宫复旧情况,评估3组产妇药品不良反应。结果A组和B组产后2 h及24 h出血量、恶露持续时间和住院时间分别为[A:(343.58±49.32)mL,(426.35±68.65)mL,(18.25±3.21)d,(5.26±0.25)d;B:(341.63±54.27)mL,(431.25±63.59)mL,(17.98±2.66)d,(5.34±0.32)d]比较,差异无统计学意义(t=0.168,0.325,0.398,1.261,P=0.867,0.746,0.692,0.211)(P>0.05);C组产后2 h及24 h出血量,恶露持续时间和住院时间分别为(215.65±42.36)mL,(301.36±50.35)mL,(14.21±2.14)d,(4.21±0.43)d,均少于A组和B组(C vs A:t=16.968,13.030,9.465,20.289,均P<0.001;C vs B:t=15.267,12.372,8.070,19.950,均P<0.001)。3组产后出血发生率分别为4.17%,30.3%,0,差异无统计学意义(P=0.624)。A组和B组产后3 d、5 d的子宫下降程度分别为[A:(2.09±0.18)cm,(4.03±0.25)cm;B:(2.16±0.39)cm,(4.15±0.34)cm],均差异无统计学意义(t=1.088,1.831,P=0.280,0.071),C组以上指标分别为(2.94±0.23)cm,(4.89±0.29)cm,均大于A组和B组(C vs A:t=20.460,17.154,均P<0.001;C vs B:t=19.177,15.077,均P<0.001)。A,B,C组患者总不良反应发生率分别为14.58%,9.09%,24.32%,差异无统计学意义(χ^(2)=3.134,P=0.209)。结论卡前列素氨丁三醇与麦角新碱均可有效促进子宫收缩,预防产后出血,促进子宫复旧,两者联合可能具有协同作用,可更进一步的提高临床效果。

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.

催产素预防产后出血的研究进展

产后出血是常见的产科并发症,是导致全球孕产妇死亡的首要原因,子宫收缩乏力是导致产后出血的主要原因。催产素及卡贝催产素等子宫收缩剂是预防和治疗子宫收缩乏力的一线药物,催产素作为预防产后出血的首选药物和世界卫生组织推荐的一线子宫收缩剂,其在不同分娩方式中的用药途径、给药时机、剂量和给药速率等方案尚未达成一致。其中多胎妊娠、肥胖等产后出血高危人群中催产素的使用方案与低危人群不同,现有研究的热点是在产后出血高危人群中,如何以最低剂量达到最佳的预防效果,减少药物的不良反应。综述催产素预防产后出血及其给药方案,总结催产素在不同分娩方式中的应用并对未来的研究方向作出展望。

卡前列素氨丁三醇联合宫腔球囊填塞治疗前置胎盘剖宫产产后出血对出血量情况的影响分析

目的 探究与分析卡前列素氨丁三醇联合宫腔球囊填塞治疗前置胎盘剖宫产产后出血对出血量情况的影响。方法 目的选取2020年3月—2022年8月山东省潍坊市临朐县人民医院收治的80例前置胎盘剖宫产产后出血患者为研究对象并按照治疗方法不同分为两组,每组40例,对照组采取缩宫素联合卡前列素氨丁三醇治疗,观察组加用宫腔球囊填塞治疗,对比两组临床疗效、手术时间、首次月经时间、白细胞计数、血清C反应蛋白、出血量、住院时间及输血率、子宫切除率。结果 观察组临床总有效率为95.00%,较对照组(77.50%)高,差异有统计学意义(χ^(2)=5.165,P<0.05)。观察组手术时间、首次月经时间、白细胞计数、血清C反应蛋白水平、术中出血量、产后2 h出血量、产后24 h出血量、住院时间均优于对照组,差异有统计学意义(P均<0.05)。结论 卡前列素氨丁三醇联合宫腔球囊填塞治疗前置胎盘剖宫产产后出血可获得更好的临床疗效,围术期指标表现较好,同时可降低输血率以及子宫切除率,可获得更好的预后。