第三产程胎盘剥离延缓适时人工干预预防产后出血的临床研究  

Timely Intervention for Preventing Postpartum Hemorrhage during Delayed Placental Separation in the Third Stage of Labor

作　　者：周小飞[1] 洪瑛 向爱清[1] 温瑞珍[1] 罗莉萍[1] 

机构地区：[1]江西省妇幼保健院产科,南昌330006

出　　处：《南昌大学学报（医学版）》2013年第7期13-15,共3页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生厅普通科技计划(20113094)

摘　　要：目的探讨第三产程胎盘剥离延缓适时人工干预对减少产后出血量及缩短第三产程的作用。方法以胎儿娩出10min后胎盘仍无剥离迹象的产妇120例为研究对象,按随机数字表法分为研究组和对照组各60例。研究组立即再次给予人工干预:缩宫素10U+生理盐水20mL静脉推注,子宫按摩5min,有控制的牵拉脐带协助胎盘娩出。对照组不给予任何干预。观察第三产程时间、产后2h内及24h总出血量及胎盘剥离情况。结果研究组第三产程时间为(17.2±6.3)min,明显短于对照组的(24.3±7.2)min(P<0.05);第三产程延长发生率研究组为10.0%(6/60),明显低于对照组的21.6%(13/60)(P<0.05);研究组产后2h内和24h总出血量及产后出血发生率分别为(192.5±38.4)、(280.5±41.5)mL,16.7%(10/60),明显少于对照组的(256.5±41.2)、(378.6±54.3)mL,31.6%(19/60),差异均有统计学意义(均P<0.05)。结论第三产程胎盘剥离延缓者适时再给予人工干预可有效减少产后出血量、对预防产后出血发生及第三产程延长有明显的作用。Objective To investigate the role of timely intervention in reducing postpartum hemorrhage and shortening the third stage of labor during the delayed placental separation in the third stage of labor. Methods A total of 120 puerperas whose placentas were not separated after 10 minutes in the third stage of labor were randomly divided into two groups, with 60 puerperas in each group（P〈0.05）. The research group was again given manual interventions, including in- travenous injection of oxytocin （10 U） and physiological saline （20 mL）, uterine massage （5 mi- nutes）, and controlled cord traction to help placental separation（P%0.05）. The control group received no interventions. The duration of the third stage of labor, total amount of blood loss and situation of placental separation within 2 and 24 hours were observed. Results The duration of the third stage of labor was （17.2±6.3） minutes in research group and （24.3±7.2） minutes in control group（P〈0.05）. The incidence of the extension of the third stage of labor was 10.0% （6/60） in research group and 21.6% （13/60） in control group（P%0.05）. The amount of blood loss within 2 and 24 hours was, respectively, （192.5±38.4） and （280.5±41.5） mL in research group and （256.5±41.2） and （378.6±54.3） mL in control group（P〈0.05）. The incidence ofpostpartum hemorrhage was 16. 7% （10/60） in research group and 31. 6% （19/60） in control group（P〈0.05）. Conclusion Timely interventions can effectively reduce and prevent postpartum hemorrhage and shorten the duration of the third stage of labor during the delayed placental sepa- ration in the third stage of labor.

关 键 词：产后出血 第三产程 胎盘剥离 缩宫素 子宫按摩 预防 

分 类 号：R714.461[医药卫生—妇产科学]