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.

Surgical first aid and nursing care of a parturient with massive hemorrhage in natural delivery

Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.

Effects of midwife-led psychological intervention on delivery outcomes:a meta-analysis

Objective:To systematically review the influence of psychological intervention of midwives on the delivery mode and outcomes.Methods:Databases including Cochrane Library,PubMed,Medline,EMBASE,CINAHL,CNKI,Wangfang,and VIP were searched for randomized controlled trials studying the effects of midwife-led psychological nursing on puerpera.Two evaluators independently searched and screened the papers,extracted relevant data,and quality assessment of the included studies,followed by a meta-analysis of the papers using RevMan 5.3 software.Results:12 studies with 1,395 patients were included.The results of the meta-analysis showed that compared to conventional nursing,midwife-led psychological intervention can improve the number of people who choose natural delivery[Z=7.53,95%CI(2.07,3.45),P<0.001],shorten the duration of the first stage of delivery[Z=45.10,95%CI(-4.43,-4.06),P<0.001),reduce postpartum hemorrhage after delivery for two hours[Z=21.68,95%CI(-63.92,-53.32),P<0.001];these differences were statistically significant.Conclusion:Psychological interventions led by midwives can improve the natural delivery rate of pregnant women,shorten the duration of the first stage of delivery,and decrease postpartum hemorrhage after delivery for two hours;thus,it can be popularized for clinical use.

Intravenous Administration of Carbetocin Versus Oxytocin for Preventing Postpartum Hemorrhage After Vaginal Delivery in High Risk Women:A Double-blind,Randomized Controlled Trial

Objective::To compare the effects between carbetocin and oxytocin on reducing postpartum hemorrhage(PPH)after vaginal delivery in high risk pregnant women.Methods::A prospective double-blinded randomized study was conducted in the Nanjing Drum Tower Hospital from March to May 2018.Women at or beyond 28 gestational weeks,cephalic presentation,18-45 years old,and with at least one risk factor for PPH,were enrolled.Using a computer-generated randomization sequence,women were randomized to carbetocin group or oxytocin group which receive 100μg intravenous infusion carbetocin or 10 IU intravenous infusion of oxytocin after anterior shoulder and before placental delivery.The primary outcome was the incidence of blood loss≥500 mL within 24 hours postpartum.The secondary outcomes were amount of total blood loss,blood loss within 2 hours after delivery,the rate of blood loss≥1000 mL postpartum,need for a second-line uterotonics and interventions,blood transfusion,difference between hemoglobin before and 48 hours after delivery,adverse maternal events attributed to the trial medication.Hemodynamic status(blood pressure and pulse)was measured at 0 minutes,30 minutes,60 minutes,and 120 minutes after delivery.Results::A total of 314 and 310 participants constituted the carbetocin and oxytocin groups,respectively.The baseline characteristics were comparable between the groups.The carbetocin group had similar rates of PPH(blood loss≥500 mL)and rates of≥1000 mL PPH,(29.6%vs.26.8%,P=0.48)and(3.2%vs.3.5%,P=0.83),to the oxytocin group.The average amount of bleeding was(422.9±241.4)mL in carbetocin group and(406.0±257.5)mL in oxytocin group,which was no statistically significant difference(P=0.40).Either the amount of blood loss within 2 hours((55.5±33.9)mL vs.(59.9±48.7)mL)was no statistically significant difference(P=0.19).The need for therapeutic uterotonics was 23.9%in carbetocin group and 23.5%in oxytocin group,which was also no statistically difference(P=0.93).The rate of blood transfusion(P=0.62)and hemoglobin change(P=0.07)were not differ between the carbetocin and oxytocin groups.However,the rate of manually removing placenta was significantly different between two groups regarding the need for manually remove of placenta because of uterine bleeding in the third stage of labor(4 cases in carbetocin group vs.13 cases in oxygen group),especially in those after oxytocin-induced or augmented labor(relative risk:3.39,95%confidence interval:1.09-10.52).After delivery,the blood pressure in the carbetocin group tend to be lower than that in the oxytocin group(P>0.05),especially at 30 minutes postpartum(P<0.05),while pulse tend to be simultaneously higher(P>0.05).Conclusion::Among women with high risk of PPH,intravenous carbetocin infusion did not better than oxytocin in the prevention of blood loss≥500 mL after vaginal delivery.

Tranexamic Acid and Ethamsylate for Reducing Blood Loss in Patient Undergoing Lower Segment Cesarean Section at High Risk for Post-Partum Hemorrhage: A Pilot Study

Objective: To assess the efficacy of intravenous tranexamic acid and ethamsylate in reducing blood loss during and after elective lower segment cesarean delivery in patients at high risk for postpartum hemorrhage. Methods: A double-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term pregnancy at high risk for postpartum hemorrhage at Ain Sham University Maternity Hospital in Cairo, Egypt, between January 2019 and October 2019. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1 g tranexamic acid and 1 gm ethamsylate or 5% glucose (placebo) just after delivery of the fetus. Prophylactic oxytocin was administered to all women. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during the cesarean, which was the primary outcome. Results: Analyses included 32 women in each group. Our results showed that tranexamic acid and ethamsylate significantly reduced bleeding during and after cesarean delivery. The study group’s total blood loss (149.22 ± 54.74 ml) was significantly less than the control group (353.75 ± 115.56 ml) (p < 0.001). In our study, postoperative hemoglobin and hematocrit were significantly higher in the study group than the control group (p < 0.001);Reduction in hemoglobin and hematocrit were significantly less in the study group than the control group (p < 0.001). Conclusion: The use of tranexamic acid and ethamsylate during cesarean delivery can significantly reduce blood loss during and after cesarean delivery.

中医穴位按摩联合自由体位对初产妇阴道分娩产程时间及产后出血量的影响

目的:探讨中医穴位按摩联合自由体位对初产妇阴道分娩产程时间及产后出血量的影响。方法:选取2021年6月-2023年6月于本院分娩的初产妇120例,随机分组,其中采用常规分娩模式产妇为常规组,采用中医穴位按摩联合自由体位分娩产妇为联合组,比较两组产程时间及产后出血量。结果:联合组阴道分娩率(91.7%)高于常规组(75.0%),第1产程(356.4±69.0 min)、第2产程(34.5±10.8 min)、第3产程(6.1±1.1 min)时间均短于常规组(442.2±82.6 min、46.1±14.5 min、9.6±1.5 min),分娩时疼痛等级≤2级占比(90.0%)高于常规组(68.3%),分娩控制感评分(178.41±19.68分)高于常规组(121.88±16.54分),产后出血量(208.4±30.0 ml)及分娩时并发症(11.7%)发生率低于常规组(292.5±37.3ml、31.7%)(均P<0.05)。结论:应用中医穴位按摩联合自由体位能够减少初产妇剖宫产率,缩短产程,减轻分娩疼痛,减少产后出血量,降低分娩并发症发生。

预见性护理干预在经阴道分娩产后出血防护中的效果

目的分析预见性护理干预在经阴道分娩产后出血防护中的效果。方法选取60例经阴道分娩产妇,采取随机分组法分为对照组和观察组,每组30例。对照组采用常规性护理干预,观察组采用预见性护理干预。比较两组产妇产后2h及产后24h出血量、产后出血发生率、抑郁自评量表(SDS)及焦虑自评量表(SAS)评分。结果观察组产后2h及产后24h出血量明显少于对照组(P<0.05)。观察组产后出血发生率为3.3%,低于对照组的20.0%(P<0.05)。干预后,观察组SDS、SAS评分均明显低于对照组(P<0.05)。结论将预见性护理干预应用于经阴道分娩产妇的产后出血防护中,有助于进一步改善其产后出血情况与负性情绪,值得在产科应用与推广。

个体化干预对妊高征产妇分娩结局的影响

目的 探讨个体化干预对妊娠高血压综合征(妊高征)产妇产后出血、分娩结局及患者心理状态的影响。方法 选取2022年2月至2023年2月收治的85例妊高征产妇,随机分为观察组43例和对照组收缩压42例。对照组采用常规护理干预,观察组采用个体化护理干预。2组产妇一般资料(年龄、孕周、妊高征程度),干预前后血压,分娩结局,并发症情况,心理状态,新生儿1 min Apgar评分。结果 2组患者干预前收缩压(SBP)、舒张压(DBP)比较无明显差异(P>0.05),干预后2组患者SBP、DBP显著降低(P<0.05),干预后观察组患者SBP、DBP显著低于对照组(P<0.05);2组患者Apgar评分比较差异有统计学意义(P<0.05),观察组新生儿窒息发生率明显低于对照组(P<0.05);观察组剖宫产率、分娩后总不良反应发生率(包括产褥感染、产后出血等并发症)显著低于对照组(P<0.05),而阴道分娩率显著高于对照组(P<0.05),2组患者干预前SAS、SDS评分比较无明显差异(t=0.65,0.43,P>0.05),干预后2组患者SAS、SDS评分均较干预前显著降低(t=12.75,11.48,P<0.05),观察组患者SAS、SDS评分显著低于对照组(t=11.54,11.23,P<0.05),差异有统计学意义。结论 个体化干预能有效预防妊高征产妇产后出血,改善妊高征产妇分娩结局及缓解患者心理状态,值得临床推广。

产后出血产妇采取卡前列素氨丁三醇联合缩宫素治疗后对其出血量的影响

目的探讨产后出血产妇采取卡前列素氨丁三醇联合缩宫素治疗后对其出血量的影响。方法100例产后出血产妇作为研究对象,根据治疗方式不同分为对照组(50例,采取缩宫素治疗)和观察组(50例,采取卡前列素氨丁三醇联合缩宫素治疗)。比较两组产妇的出血量、不良反应发生情况、治疗效果。结果治疗后2、12、24、36 h,观察组的出血量分别为(235.89±26.12)、(272.31±29.45)、(288.89±25.20)、(299.31±31.45)ml,均少于对照组的(306.45±22.24)、(351.81±31.81)、(386.45±26.24)、(405.81±31.81)ml,差异明显(P<0.05)。治疗后,观察组产妇的不良反应发生率2.00%低于对照组的14.00%,差异明显(P<0.05)。治疗后,观察组的总有效率98.00%高于对照组的84.00%,差异明显(P<0.05)。结论对产后出血产妇采用卡前列素氨丁三醇联合缩宫素治疗后,能降低产妇的出血量,减少不良反应的发生,提高治疗效果,影响较大。

PDCA循环管理在降低阴道分娩并发症发生率中的效果

目的运用PDCA(plan-do-check-action)管理法分析阴道分娩并发症发生的原因,针对要因制订和实施改进措施,探讨PDCA循环应用于降低阴道分娩并发症的效果,为产科降低分娩并发症提供科学的管理方法。方法收集肇庆市第一人民医院2020年1—12月实施PDCA循环管理前的2170份阴道分娩产妇病案作为对照组,2022年1—12月实施PDCA循环管理后的2697份阴道分娩产妇病案作为试验组。比较PDCA循环管理法实施前后2组阴道分娩并发症发生率的差异。结果运用PDCA循环管理法,通过完善规章制度流程、加强督导和反馈、强化全员培训,使阴道分娩并发症发生率从2020年的31.66%下降到2022年的17.35%,差异有统计学意义(P<0.05)。结论PDCA循环管理法有效降低阴道分娩并发症的发生率,是医疗质量管理的一种科学的管理方法。

经产妇经阴道分娩产后出血风险列线图模型的建立及验证

目的分析经产妇经阴道分娩发生产后出血(PPH)的危险因素,并建立预测其发生风险的个体化列线图模型。方法回顾性分析2018年1月至2022年6月在广西壮族自治区妇幼保健院经阴道分娩的7207例经产妇的临床资料,将研究对象随机分为建模组(70%)与验证组(30%),根据是否发生PPH,分为PPH组(n=238)和非PPH组(n=6969)。比较非PPH组和PPH组的临床指标,将建模组数据中差异具有统计学意义的指标作为自变量,是否发生PPH为结局变量,纳入多因素Logistic回归分析,并绘制列线图。用验证组数据进行验证,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)判断模型辨别能力;绘制校准图以判断模型校准能力。结果非PPH组和PPH组年龄(χ^(2)=12.583)、孕期出血史(χ^(2)=10.576)、妊娠期高血压疾病(χ^(2)=18.066)、妊娠期糖尿病(χ^(2)=42.775)、子痫前期(χ^(2)=10.165)、多胎(χ^(2)=16.467)、产程延长(χ^(2)=7.570)、巨大胎儿(χ^(2)=14.306)、凝血功能异常(χ^(2)=62.961)、宫缩乏力(χ^(2)=32.305)、前置胎盘(χ^(2)=20.374)、胎盘早剥(χ^(2)=61.508)、胎盘粘连/滞留(χ^(2)=24.086)比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,孕期出血史(OR=3.003,95%CI:1.393~5.818)、子痫前期(OR=2.751,95%CI:1.347~5.106)、多胎(OR=3.990,95%CI:1.769~8.054)、产程延长(OR=1.861,95%CI:1.140~2.903)、巨大胎儿(OR=2.204,95%CI:1.431~3.287)、凝血功能异常(OR=6.221,95%CI:3.605~10.293)、宫缩乏力(OR=2.553,95%CI:1.778~3.597)、前置胎盘(OR=3.858,95%CI:2.139~6.537)、胎盘早剥(OR=4.431,95%CI:2.818~6.762)、胎盘粘连/滞留(OR=3.324,95%CI:1.969~5.353)是发生PPH的独立危险因素。验证组数据验证后,其ROC曲线的AUC为0.785;校准图其模型校准曲线与标准曲线均接近。结论孕期出血史、子痫前期、多胎、产程延长、巨大胎儿、凝血功能异常、宫缩乏力、前置胎盘、胎盘早剥、胎盘粘连/滞留是经产妇经阴道分娩发生PPH的独立危险因素。

无保护会阴接生法与传统会阴保护接生法在阴道自然分娩产妇中的应用效果比较

目的:比较无保护会阴接生法与传统会阴保护接生法在阴道自然分娩产妇中的应用效果。方法:选取2021年4月至2023年4月该院收治的280例阴道自然分娩产妇进行前瞻性研究,按随机数字表法将其分为对照组(n=140)和观察组(n=140)。对照组采用传统会阴保护接生法,观察组采用无保护会阴接生法。比较两组产程、产后出血量、住院时间,会阴损伤率、产后尿潴留发生率、产后不同时间疼痛程度[视觉模拟评分法(VAS)]评分和产妇满意度。结果:两组第一、第二、第三产程比较,差异均无统计学意义(P>0.05);观察组产后出血量少于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05);观察组会阴侧切率、会阴裂伤率、会阴水肿率、产后尿潴留发生率均低于对照组,差异有统计学意义(P<0.05);产后当天、产后48 h、出院当天,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组产妇满意度高于对照组,差异有统计学意义(P<0.05)。结论:无保护会阴接生法应用于阴道自然分娩产妇可提高产妇满意度,减少产后出血量,缩短住院时间,降低会阴损伤率、产后尿潴留发生率和产后疼痛程度评分,其效果优于传统会阴保护接生法。

预见性护理预防产后出血在阴道分娩产妇中的应用效果

目的分析对阴道分娩产妇实施预见性护理对预防产后出血的应用价值。方法选取50例阴道分娩产妇,按照随机抽签法分为对照组与观察组,每组25例。对照组采用常规护理,观察组在对照组基础上采用预见性护理干预,对比两组护理效果。结果观察组产后出血率低于对照组,产后2 h、24 h出血量均少于对照组(P<0.05)。观察组的服务态度、操作技能、安全护理与健康宣教评分均高于对照组(P<0.05)。护理后观察组的焦虑、抑郁评分均低于对照组(P<0.05)。结论对阴道分娩产妇开展预见性护理价值较高,可有效预防产后出血发生,提高护理质量,缓解产妇负性情绪。

双侧子宫动脉上行支结扎术在防治前置胎盘剖宫产产后出血中的应用

目的:探讨双侧子宫动脉上行支结扎术在防治前置胎盘剖宫产产后出血(PPH)中的临床效果。方法:选取2018年3月—2023年3月黔东南苗族侗族自治州剑河县人民医院拟行剖宫产治疗的前置胎盘产妇孕60例为研究对象,按随机数字表法分为对照组及研究组,各30例。对照组采用宫腔填塞止血,研究组采用双侧子宫动脉上行支结扎术止血。比较两组围术期相关指标(PPH发生率、术中及术后24 h出血量、手术时间、住院时间)及术后并发症。结果:研究组PPH发生率低于对照组,差异有统计学意义(P=0.012);研究组术中出血量、术后24 h出血量少于对照组,手术时间及住院时间短于对照组,差异有统计学意义(P<0.05);研究组术后并发症发生率低于对照组,差异有统计学意义(P<0.001)。结论:前置胎盘剖宫产术中采用双侧子宫动脉上行支结扎术能够减少术中及术后出血量,降低PPH发生率、术后并发症发生率,缩短手术时间及住院时间。

低危产妇经阴道分娩产后出血风险预测模型的构建

目的:探讨低危产妇经阴道分娩产后出血的相关因素并构建产后出血风险预测模型,为预测产后出血的风险提供依据。方法:选取2019年6月—2022年12月在汕头大学医学院第二附属医院住院的429例经阴道分娩、无妊娠并发症及合并症的单胎低危产妇为研究对象。根据纳入时间排序,将研究对象分为训练集(331例)和验证集(98例)。以是否发生产后出血,训练集分为出血组(112例)、未出血组(219例),验证集分为出血组(32例)、未出血组(66例)。通过多因素logistic回归分析筛选产后出血的相关因素并构建列线图预测模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积评估预测模型的区分度。采用Hosmer-Lemeshow(HL)拟合优度检验及校准曲线评估预测模型的校准度。结果:多因素logistic回归分析显示产妇的宫高(OR=1.326,95%CI:1.179~1.446)、产前体重指数(OR=1.111,95%CI:1.020~1.211)、孕次(OR=2.128,95%CI:1.167~3.879)、第三产程时间(OR=1.072,95%CI:1.022~1.124)、血小板计数(OR=0.990,95%CI:0.986~0.996)是产后出血的相关因素。由这5个因素构建的预测模型在训练集的ROC曲线下面积为0.786(95%CI:0.732~0.839),验证集ROC曲线下面积为0.840(95%CI:0.803~0.869),训练集HL检验的P值为0.529,验证集HL检验的P值为0.893,校准曲线均接近理想曲线,表明预测模型的区分度、校准度均良好。结论:本研究构建的预测模型对低危产妇经阴道分娩产后出血的风险有较好的预测能力。

导乐陪伴家庭化护理干预对初产妇分娩疼痛、心理状态及分娩结局的影响观察

目的分析导乐陪伴家庭化护理干预对初产妇分娩疼痛、心理状态及分娩结局的影响。方法选取60例初产妇,按照红蓝信封法分为常规组与导乐组,每组30例。常规组采用常规护理,导乐组采用导乐陪伴式家庭化护理干预。比较两组干预效果。结果导乐组第一、二、三产程均短于常规组(P<0.05)。护理后导乐组焦虑、抑郁评分均低于常规组(P<0.05)。导乐组分娩疼痛评分低于常规组,产后2h出血量明显少于常规组(P<0.05),两组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。导乐组不良妊娠结局发生率3.33%明显低于常规组的20.00%(P<0.05)。结论导乐陪伴式家庭化护理干预应用于初产妇分娩时,可缩短产程用时,改善其心理状态及分娩指标,保证分娩结局,值得临床推广。

Postpartum Hemorrhage Following Cesarean Delivery in Women with a Scarred Uterus:A Retrospective Cohort Study

Objective:To develop a model to predict the risk of postpartum hemorrhage(PPH)following cesarean delivery in women with a scarred uterus.Methods:A total of 4,637 pregnant women with scarred uterus who underwent a cesarean delivery at a large hospital between January 2014 and December 2017 were enrolled.The women were divided into PPH(n=287)and non-PPH(n=4,350)groups.A model to predict PPH(blood loss≥1,000 mL within 24 h following cesarean delivery)was developed using multivariate logistic regression analysis.Receiver operating characteristic curve was drawn,and the area under curve(AUC)was calculated.Results:The incidence of PPH was 6.19%(287 of 4,637 women).Seven independent risk factors were associated with PPH:maternal age(odds ratio[OR]=1.42,95%confidence interval[CI]:1.02-1.97),previous gravidity(OR=1.24,95%CI:1.01-1.50),placental location(posterior wall of uterus,OR=0.69,95%CI:0.47-1.02;other locations,OR=1.21,95%CI:0.81-1.80),placenta previa(incomplete placenta previa,OR=10.51,95%CI:5.99-18.42;complete placenta previa,OR=31.65,95%CI:21.07-47.54),placenta accreta(OR=6.39,95%CI:4.02-10.16),hypertensive disorders of pregnancy(OR=2.27,95%CI:1.40-3.68),and fetal position(breech position,OR=2.07,95%CI:1.19-3.60;transverse position,OR=1.07,95%CI:0.48-2.41).A predictive model with AUC of 0.89 was developed(95%CI:0.86-0.91,P<0.001).Conclusions:A model was developed to predict PPH following cesarean delivery in women with a scarred uterus.

B-Lynch术与宫腔内水囊压迫结合在难治性产后出血中的应用价值

目的:探讨B-Lynch术联合宫腔内水囊压迫在难治性产后出血中的应用效果。方法:回顾性选取2018年3月至2022年1月期间我院收治的100例难治性产后出血患者的临床资料作为研究对象,依据治疗方法不同分为常规组(n=48)与研究组(n=52)。常规组采用宫腔内水囊压迫止血;研究组再常规组的基础上联合B-Lynch术。比较两组止血有效率、围手术期指标(术中出血量、产后恶露持续时间、产后2 h、24 h阴道出血量、止血时间)、术前与术后24 h凝血功能指标(活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)、凝血酶原时间(Prothrombin time,PT)、凝血酶时间(Thrombin time,TT))、应激反应指标(血清醛固酮(Aldosterone,ALD)、肾上腺素(Epinephrine,E)、去甲肾上腺素(Norepinephrine,NE))。结果:研究组止血有效率明显较常规组高,术中出血量、产后2 h、24 h阴道出血量明显较常规组少,产后恶露持续时间、止血时间明显较常规组短(P<0.05);术后24 h,两组APTT、PT、TT均缩短,研究组短于常规组,血清ALD、E、NE水平均下降,研究组低于常规组(P<0.05)。结论:B-Lynch术联合宫腔内水囊压迫止血应用于难治性产后出血中,可改善凝血功能,减轻应激反应,提高止血有效率,减少出血量,促进产后康复。

产时超声联合阴道检查对分娩方式评估的临床研究

目的探索研究产超声联合阴道检查对分娩方式评估的临床应用效果。方法选取九江市妇幼保健院2022年7月至2023年3月分娩的100例产妇,按照随机数字表分组原则,将100例产妇平均分为对照组(阴道触诊评估,n=50)、观察组(产时超声联合阴道触诊评估,n=50)。详细记录两组胎头进展角(AOP)、胎头-会阴距离(HPD)、中线角度(MLA)、胎头方向,等一系列分娩数据,研究分析两组临床评估效果。结果与对照组(阴道触诊)相比,观察组(产时超声联合阴道触诊)自然分娩率(90.00%νs.84.00%)更高,剖宫产率(10.00%νs.16.00%)更低(P<0.05)。观察组(产时超声联合阴道触诊)活跃期、活跃期/潜伏期HPD、AOP表达水平低于对照组(P<0.05);但是两组潜伏期HPD、AOP指标比较,组间差异无统计学意义(P>0.05)。观察组产后出血、产时损伤、产后感染、新生儿窒息等不良情况发生率均低于对照组(P<0.05)。观察组新生儿Apgar评分(9.85±0.11νs.9.15±0.34)高于对照组,组间差异有统计学意义(P<0.05)。结论在产程中实施产时超声联合阴道检查,能尽快发现异常产程并提供干预,预测分娩方式,降低阴道分娩过程中严重并发症发生率、中转剖宫产发生率,改善母婴双方的分娩结局,值得推荐。

缩宫素联合卡孕栓对经阴道分娩试产高危产妇产后出血的防治效果分析

目的 探讨缩宫素联合卡前列甲酯栓(商品名:卡孕栓)对经阴道分娩试产高危产妇产后出血的防治效果。方法 70例待产且接受阴道分娩试产的高危产妇,应用随机数字表法将其分成对照组和研究组,各35例。对照组产妇应用缩宫素,研究组产妇应用缩宫素联合卡孕栓。对比两组产程时间、产后出血量、产后出血发生情况、凝血指标[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、血常规指标、心理状态评分。结果 两组第一产程、第二产程时间对比均未发现明显差异(P>0.05);研究组第三产程时间(8.34±1.18)min比对照组的(10.92±1.54)min短(P<0.05)。研究组产后2 h出血量(336.43±65.74)ml、产后24 h出血量(413.16±49.07)ml均比对照组的(389.81±58.92)、(493.49±72.34)ml少,产后出血发生率2.86%比对照组的17.14%低(P<0.05)。干预后,两组TT、PT、APTT与干预前对比均显著延长,但研究组TT、PT、APTT均比对照组短(P<0.05)。干预后,两组血红蛋白、红细胞计数相比干预前均显著降低,但研究组血红蛋白(121.53±3.41)g/L及红细胞计数(3.79±0.45)×10^(12)/L均比对照组的(116.85±3.28)g/L、(3.28±0.39)×10^(12)/L高(P<0.05)。干预后,两组焦虑和抑郁评分均较干预前显著降低,且研究组焦虑和抑郁评分均较对照组更低(P<0.05)。结论 对经阴道分娩试产的高危产妇联用缩宫素与卡孕栓可加快第三产程进展,有效预防与治疗产后出血,并对凝血功能、血常规指标影响减小,有利于减轻产妇产后的负性情绪。