第三产程产后出血防治措施的分析  

Clinical Study on Preventing and Curing Postpartum Hemorrhage in the Third Stage of Labor

作　　者：赵少飞[1] 孙晓峰[1] 

机构地区：[1]广东省妇幼保健院,广东广州510010

出　　处：《实用妇产科杂志》2003年第5期278-280,共3页Journal of Practical Obstetrics and Gynecology

基　　金：广东省社会重大问题联合攻关课题基金资助 (ZKB0 4 70 1S)

摘　　要：目的 :探讨第三产程产后出血的防治措施。方法 :前瞻性观察我院住院分娩的产妇 45 0例 ,其中阴道分娩30 0例 ,随机分为 5组。A组 :缩宫素组 (6 0例 ) ,于胎儿娩出后静脉推注生理盐水 2 0ml加缩宫素 2 0U ;B组 :卡前列甲酯组 (6 0例 ) ,于胎儿娩出后将卡前列甲酯 1mg塞肛 ;C组 :手法按摩组 (6 0例 ) ,胎儿娩出后手法持续宫底按摩≥ 5分钟 ,适度牵拉脐带 ;D组 :缩宫素加手法按摩组 (6 0例 ) ;对照组 (6 0例 ) :于胎儿娩出后静脉滴注生理盐水 5 0 0ml。另 15 0例剖宫产分娩者 ,随机分为 3组 ,A组 :缩宫素组 (5 0例 ) ;B组 :手法组 (5 0例 ) ;C组 :缩宫素加手法组 (5 0例 )。准确测量产后 2小时及 2 4小时出血量 ,记录第三产程时间。结果 :阴道分娩各组中 ,D组的第三产程时间最短 ,产后 2小时内出血量最少 ,C组、B组、A组依次减少 ;剖宫产各组中 ,C组的产后出血量及产后出血发生率与A组、B组相比 ,差异有显著性 ;剖宫产组产后出血量与阴道分娩组比较 ,其差异也有统计学意义。结论 :胎儿娩出后及时使用缩宫素或卡前列甲酯等促宫缩药 ,并采取主动手法辅助娩出胎盘 ,可减少产后出血 ,其预防产后出血的效果显著优于上述其他处理方法。Objective: To investigate the preventing measure for postpartum hemorrhage in the third stage of labor . Methods: This prospective study was performed in 450 pregnant women of our hospital . 300 cases who underwent vaginal delivery were randomly assigned into five groups . Group A(n=60):20 U Oxytocin was injected intravenously after delivery of the fetus. Group B(n=60):Parturients were administered carboprost suppository into the rectum as soon as the fetus delivered . Group C(n=60):The manual technique of continued kneading uterine bottom and gently pulling the cord was applied . Group D(n=60):Oxytocin and mannal technique were combined. Group E(n=60):N.S 500 ml was administered intravenously. 150 patient who were candidates for cesarean delivery were assigned randomly to three groups , including Oxytocin using group(groupA,n=50) ,mannal technique group(groupB,n=50) , Oxytocin mannal technique group(groupC,n=50) . The amount of blood loss within 2 hours and 24 hours were measured precisely , the lasting time of the third stage of labor were noted . Results: In all normal vaginal labor, the lasting time of the third stage of labor in group D was the shortest , and group C ?B?A followed in turn . In all cesarean delivery , the difference in the amout of vaginal bleeding and the occurrences of postpartum hemorrhage between group C and other groups (A and B) was significant . There was statistic ally difference about postpartum bleeding between the vaginal delivery and cesaren section . Conclutions: Oxytocin and Carboprost suppository used in third age of labor are efficient in reducing the postpartum hemorrhage ,and the patterns of delivery of placenta by manual technique is the best one.

关 键 词：第三产程 产后出血 防治 阴道分娩 缩宫素 

分 类 号：R714.461[医药卫生—妇产科学]