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
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...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 age28 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 albumin30 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.展开更多
目的探讨回收式自体输血联合双侧髂内动脉球囊预置术对出血高危患者在剖宫产术中的应用效果。方法前瞻性选取本院2021年1月—2023年5月的162名进行剖宫产的出血高危患者,根据输血方式适应证不同分为A、B、C 3组,每组各54例。A组采用异...目的探讨回收式自体输血联合双侧髂内动脉球囊预置术对出血高危患者在剖宫产术中的应用效果。方法前瞻性选取本院2021年1月—2023年5月的162名进行剖宫产的出血高危患者,根据输血方式适应证不同分为A、B、C 3组,每组各54例。A组采用异体血输入,B组采用自体血输入,C组采用自体输血联合双侧髂内动脉球囊预置术。结果术中出血量(1600 mL vs 1500 mL vs 800 mL)、术后住院时间(7 d vs 7 d vs 6 d)和手术时间(107 min vs 104.50 min vs 77 min)C组均低于A、B 2组(P<0.05),A、B 2组比较无差异(P>0.05);C组输入自体血量低于B组(525.5 mL vs 261 mL,P<0.05)。C组异体红细胞的输入占比低于A组(22.22%vs 100.00%,P<0.0167);C组血浆的输入占比低于A、B 2组(18.50%vs 66.70%/18.50%vs 44.40%,P<0.0167);C组凝血功能障碍发生率低于A组(7.41%vs 25.93%,P<0.0167);C组子宫切除发生率低于A组(1.85%vs 16.67%,P<0.0167),A、B 2组比较无差异(16.67%vs 11.11%,P>0.0167)。结论在出血高危患者剖宫产术中采用回收式自体输血联合双侧髂内动脉球囊预置术效果理想,能明显减少术中失血量、术中自体血回输量、异体红细胞和血浆成分的输入量,同时减少手术时间和术后住院时间。此外,还改善凝血功能和子宫切除情况,有利于保障产妇的生命安全和促进早期康复,且一定程度保留患者生育能力,值得临床进一步推广。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.
文摘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 age28 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 albumin30 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.
文摘目的探讨回收式自体输血联合双侧髂内动脉球囊预置术对出血高危患者在剖宫产术中的应用效果。方法前瞻性选取本院2021年1月—2023年5月的162名进行剖宫产的出血高危患者,根据输血方式适应证不同分为A、B、C 3组,每组各54例。A组采用异体血输入,B组采用自体血输入,C组采用自体输血联合双侧髂内动脉球囊预置术。结果术中出血量(1600 mL vs 1500 mL vs 800 mL)、术后住院时间(7 d vs 7 d vs 6 d)和手术时间(107 min vs 104.50 min vs 77 min)C组均低于A、B 2组(P<0.05),A、B 2组比较无差异(P>0.05);C组输入自体血量低于B组(525.5 mL vs 261 mL,P<0.05)。C组异体红细胞的输入占比低于A组(22.22%vs 100.00%,P<0.0167);C组血浆的输入占比低于A、B 2组(18.50%vs 66.70%/18.50%vs 44.40%,P<0.0167);C组凝血功能障碍发生率低于A组(7.41%vs 25.93%,P<0.0167);C组子宫切除发生率低于A组(1.85%vs 16.67%,P<0.0167),A、B 2组比较无差异(16.67%vs 11.11%,P>0.0167)。结论在出血高危患者剖宫产术中采用回收式自体输血联合双侧髂内动脉球囊预置术效果理想,能明显减少术中失血量、术中自体血回输量、异体红细胞和血浆成分的输入量,同时减少手术时间和术后住院时间。此外,还改善凝血功能和子宫切除情况,有利于保障产妇的生命安全和促进早期康复,且一定程度保留患者生育能力,值得临床进一步推广。
