米索前列醇在有高危出血因素剖宫产术中的应用

目的:观察米索前列醇用于有高危出血因素剖宫产者预防产后出血的效果.方法:选择有产后出血高危因素剖宫产者68例,随机分为观察组及对照组,观察组38例,胎儿娩出后宫体注射缩宫素20 U、静脉注射缩宫素20 U,同时术中口服米索前列醇.对照组30例,胎儿娩出后宫体注射缩宫素20 U,再静脉注射缩宫素20 U.观察两组术中及术后2小时内出血量.结果:观察组术中及术后2小时平均出血量252 4±56 ml,与对照组358±63 ml比较,差异有高度统计学意义(P<0.01).两组患者血压、血氧饱和度、心率的影响比较,差异无统计学意义(P>0.05).结论:在常规使用缩宫素的同时,采用术中口服米索前列醇,预防有高危出血因素的患者剖宫产术后出血临床效果较好,且用药方便、安全.     

直肠用米索前列醇药物预防产后出血100例临床分析

观察100例产妇,米索前列醇直肠用药预防产后出血的临床效果。方法:选择足月妊娠阴道分娩100例,随机分为2组每组50例,用米索前列醇或催产素后对第三产程及出血量的影响。1组在胎儿娩出后直肠放置米索前列醇400微克。2组在胎儿娩出后立即肌肉注射催产素10U。结果:比较两组第三产程时间无显著差异(P>0.05)产后2小时出血量减少(P<0.01)。因此应用米索前列醇降低产后出血致产妇死亡的有效措施。     

舌下含服卡前列甲酯栓预防产后出血的临床研究

目的 探讨舌下含服卡前列甲酯栓预防产后出血的效果。方法 将正常的单胎头但足月妊娠阴道分娩者１３９０例分为两组。研究组８１０例,在第二产程末胎头娩出前舌下含服卡前列甲酯栓１ｍｇ;对照组５８０例,在胎儿娩出后静脉注射催产素２０ＩＵ,观察产后２小时出血量。结果 产后２小时内的出血量,研究组及对照组分别为１７６．４３ｍｌ和１９６．７３ｍｌ,差异有极显著性（ｐ〈０．０１）。结论 舌下含服卡前列甲酯栓促进子宫     

口服米索前列醇与经静脉注射人工合成催产素对减少剖宫产术中出血效果的对照性研究

为比较米索前列醇(简称米索)和人工合成催产素在剖宫产术中预防出血的效果,选择英国亚历山大王子医院自愿参加本研究并准备在局麻下行剖宫产术的孕妇60例,随机分为2组:在胎儿娩出钳夹脐带后给予口服米索400 μg共30例,为米索组;另30例静点催产素10 IU为催产素组。     

米索前列醇在足月妊娠引产中的应用

目的：探讨米索前列醇用于足月妊娠引产的可行性及对母儿的安全性。方法：对８４例足月妊娠单胎头位初产妇，用米索前列醇口服０．１ｍｇ每小时一次，直至胎儿娩出，进行引产（米索组）。以５０例同样条件的孕妇，用催产素引产（催产素组）为对照。结果：米索组及对照组引产成功及有效率分别为９７．６％和８０．０％，Ｐ＜０．０１，有显著性差异。两组１２小时分娩成功率分别为７３．８％与４６．０％，Ｐ＜０．０１，有显著性差异。两组失败率分别为２．４％和２０．０％，Ｐ＜０．０１，有显著性差异。结论：米索前列醇口服用于足月妊娠引产疗效显著、安全、方便，有推广价值     

宫腔填塞联合米索前列醇预防高危因素剖宫产产后出血的临床疗效观察

目的:探讨宫腔填塞联合米索前列醇预防高危因素剖宫产产后出血的临床疗效。方法:有剖宫产产后出血高危因素产妇125例,随机分为A组(n=63)和B组(n=62)。A、B组所有患者均于胎儿娩出后给予子宫壁肌肉内注射缩宫素20 U、静脉滴注缩宫素10 U,手术结束后给予肛塞米索前列醇400μg。但A组另于胎盘娩出、宫腔清理后给予纱布填塞宫腔。观察术中、术后2 h、术后24 h出血量及手术时间、产褥感染、不良反应情况。结果:A组术中、术后2 h、术后24 h出血量分别为:150.3±42.3 ml,282.2±55.2 ml,355.8±92.5 ml;产后出血率为1.59%;B组术中、术后2 h、术后24 h出血量分别为:206.7±33.9 ml,456.2±75.3 ml,568.4±83.2 m1;产后出血率为12.90%;A组出血量及产后出血发生率明显低于B组(P0.05),而手术时间、产褥感染、不良反应情况组间无统计学差异(P0.05)。结论:宫腔填塞纱布联合米索前列醇预防高危因素剖宫产产后出血疗效显著,可明显减少产后出血发生率。     

催产素联合米索前列醇预防产后出血的效果分析

目的:探讨联合使用催产素和米索前列醇预防产后出血的疗效。方法:2010年1月—2011年6月共294例来我院采取剖宫产分娩且血压正常的孕妇,随机分组。一组为对照组,139例孕妇,使用催产素预防产后出血;另一组为观察组,155例孕妇,联合使用催产素和米索前列醇预防产后出血。比较两组产妇在手术过程中的出血量、术后2小时的出血量、术后24小时的总出血量,并观察产妇血压、心率的变化。结果:观察组患者手术过程中的出血量、术后2小时的出血量、术后24小时的总出血量均比对照组患者少,(P<0.05);两组患者的血压、心率变化差异无显著性,(P<0.05)。结论:联合使用催产素和米索前列醇预防产后出血有显著效果,临床在为孕妇实施剖宫产时可以采取联合用药预防出血。     

米索前列醇在预防剖宫术产后出血中的临床应用

目的:观察并探讨肛塞米索前列醇预防剖宫产产后出血的临床效果。方法:90例剖宫产产妇随机分为三组,A组产妇于胎儿娩出时宫颈肌注缩宫素,B组产妇肛塞米索前列醇片,C组产妇同时宫颈肌注缩宫素与肛塞米索前列醇片,对比三组产后2小时内的出血量、产后出血发生率及不良反应。结果:产后2小时出血量A组>B组>C组(P<0.05);产后出血发生率A组>B组>C组;三组均未出现严重不良反应。结论:肛塞米索前列醇片较缩宫素具有更好的预防产后出血的效果;两者联合使用,效果更佳。     

米索前列醇宫腔内给药用于减少剖宫产术出血的临床观察

目的:观察宫腔内直接放置米索前列醇用于减少剖宫产术中、术后出血量的临床效果。方法:选择150例有产后出血高危因素的剖宫产产妇,随机分为米索前列醇宫腔内给药组(研究组)与单纯缩宫素给药组(对照组A)、米索前列醇口服给药组(对照组B)、米索前列醇阴道给药组(对照组C)、米索前列醇直肠给药组(对照组D)5组,每组各30例。观察5组剖宫产产妇术中、术后2小时出血量、用药前后血压变化及副反应的情况。结果:研究组剖宫产术中出血量及术后2小时出血量均明显少于对照组A(P<0.01);研究组剖宫产术中出血量明显少于对照组C及对照组D(P<0.01);各组产妇用药前后的血压变化差异均无统计学意义(P>0.05);研究组无一例发生副反应。结论:米索前列醇宫腔内给药法可有效减少剖宫产术中、术后出血量,且副反应少,对血压无明显影响。     

小剂量米索前列醇用于晚期妊娠引产的效果观察

目的观察２５μｇ米索前列醇对晚期妊娠引产的有效性和安全性。方法选择有引产指征、无引产及米索前列醇使用禁忌证的单胎、头位、胎膜完整的晚期妊娠妇女４８例,随机分为Ａ组（２７例,米索前列醇２５μｇ）和Ｂ组（２１例,米索前列醇５０μｇ）。间隔４～６小时重复给药,２４小时内最大剂量为２００μｇ。胎膜破裂或临产则停止用药。结果Ａ组与Ｂ组引产成功率分别为７７．８％、８１．０％。首次用药至临产时间分别为７６９．９±３５９．９分钟、８０７．４±４０５．２分钟,首次用药至阴道分娩时间分别为９７８．６±４６４．４分钟、９７７．５±４２１．４分钟,加用催产素引产者Ａ组４例、Ｂ组２例;分娩方式、新生儿体重,两组比较,差异均无显著性（Ｐ＞０．０５）,但宫缩过强伴发胎心监护异常的发生率Ａ组低于Ｂ组。结论２５μｇ米索前列醇用于晚期妊娠引产有效而且安全     

Oral misoprostol for third stage of labor: a randomized placebo-controlled trial.

OBJECTIVE: To investigate whether orally administered misoprostol during the third stage of labor is efficient in reducing postpartum blood loss. METHODS: In a double-masked trial, during vaginal delivery women were randomly assigned to receive a single oral dose of misoprostol (600 microg) or placebo in third stage of labor, immediately after cord clamping. The third stage of labor was managed routinely by early cord clamping and controlled cord traction; oxytocin was administered only if blood loss seemed more than usual. Blood loss was estimated by the delivering physician and differences in hematocrit were measured before and after delivery. RESULTS: Mean (+/- standard error of the mean) estimated blood loss (345 +/- 19.5 mL versus 417 +/- 25.9 mL, P = .031) and hematocrit difference (4.5 +/- 0.9% versus 7.9 +/- 1.2%, P = .014) were significantly lower in women who received misoprostol than those who received placebo. Fewer women in the misoprostol group had postpartum hemorrhage (blood loss of at least 500 mL), but that difference was not statistically significant (7% versus 15%, P = .43). Additional oxytocin before or after placental separation was used less often in the misoprostol group (16% versus 38%, P = .047). There were no differences in the length of third stage of labor (8 +/- 0.9 minutes versus 9 +/- 1 minutes, P = .947). There were no differences in pain during third stage of labor, postpartum fever, or diarrhea, but shivering was more frequent in the misoprostol group. CONCLUSION: Oral misoprostol administered in the third stage of labor reduced postpartum blood loss and might be effective in reducing incidence of postpartum hemorrhage.     

卡前列甲酯栓预防产后出血的临床研究

目的：探讨卡前列甲酯栓预防产后出血的效果。方法：选择３６０例正常足月妊娠阴道分娩者，随机分为试验组和对照组。试验组２６０例，在胎儿娩出后分别向阴道或直肠置入卡前列甲酯栓１ｍｇ，各１３０例；对照组１００例，在胎儿前肩娩出后分别经臀部肌肉或肘正中静脉注射催产素１０ＩＵ，各５０例，观察产后２小时内的出血量。结果：产后２小时内平均出血量，试验组中阴道给药及直肠给药者分别为１４６．４ｍｌ及１３４．２ｍｌ；对照组肌内注射及静脉注射催产素者出血量分别为２６７．９ｍｌ及２１０．６ｍｌ。试验组与对照组相比，差异有极显著性（Ｐ＜０．０１）；而试验组阴道与直肠给药者比较，差异无显著性（Ｐ＞０．０５）。结论：卡前列甲酯栓具有比催产素更强的子宫收缩作用，能减少产后出血量，而经直肠给药方法更为简便，更适于向农村基层推广。     

Misoprostol for prevention of postpartum hemorrhage.

OBJECTIVE: To compare the effectiveness of 400 microg rectal misoprostol in 5 cm(3) of saline with oxytocin 10 IU, i.m., in reducing bleeding during the third stage of labor. DESIGN: A double blind, randomized, clinical trial including 663 women with uncomplicated vaginal delivery who received misoprostol (n=324) or oxytocin (n=339). MAIN OUTCOME MEASURES: Changes in hemoglobin and hematocrit from before to 72 h postpartum; blood loss during the third stage; duration of the third stage of labor; need for additional oxytocic drug; frequency of requisition and of administration of blood; changes in blood pressure; and occurrence of side effects. RESULTS: No significant differences were observed between groups, before and 72 h postpartum, in mean hemoglobin and hematocrit, on volume of blood loss and duration of third stage of labor. The incidence of shivering and mean temperature (P<0.01) was significantly greater among women receiving misoprostol than oxytocin. CONCLUSIONS: Misoprostol administered as a micro-enema, 400 microg in 5 ml of saline during the third stage of labor, appears to be as effective as oxytocin 10 IU, i.m., but misoprostol produced more side effects than oxytocin.     

卡前列素防治高危产妇剖宫产术中及术后出血的临床研究

目的观察卡前列素治疗有出血高危因素的产妇剖宫产术中、术后出血的有效性和安全性。方法对469例有出血高危因素（包括双胎、羊水过多、巨大儿、前置胎盘）的产妇行计划性剖宫产术。其中巨大儿239例，双胎＋羊水过多145例，前置胎盘73例。术中胎儿娩出后随机按宫缩剂使用情况分为3组，缩宫素组152例，缩宫素20U于宫体注射，另20U加入液体中静脉滴人；缩宫素＋卡前列素组192例，缩宫素20U＋卡前列素250txg宫体注射；卡前列素组125例，卡前列素250嵋于宫体注射。计算3组术中、术后2h出血量及总出血量，并观察3组的副反应。结果（1）3组产妇术中出血量分别为，缩宫素组（445±262）m1，缩宫素＋卡前列素组（332±218）m1，卡前列素组（375±265）m1，缩宫素组分别与缩宫素＋卡前列素组和卡前列素组比较，差异有统计学意义（P〈0．01，P〈0．01）。（2）3组产妇术后2h出血量分别为，缩宫素组（176±193）m1，缩宫素＋卡前列素组（110±114）m1，卡前列素组（124±103）m1，缩宫素组分别与缩宫素＋卡前列素组和卡前列素组比较，差异有统计学意义（P〈0．01，P〈0．01），缩宫素＋卡前列素组与卡前列素组比较，差异无统计学意义（P〉0．05）。（3）3组产妇中，总出血量≥1000ml共31例，其中缩宫素组15例（48％），缩宫素＋卡前列素组7例（23％），卡前列素组9例（29％）。（4）3组不同高危因素产妇出血量比较：缩宫素组中巨大儿产妇总出血量明显多于缩宫素＋卡前列素组和卡前列素组（P〈0．01，P〈0．01）；缩宫素组中双胎＋羊水过多产妇术后2h出血量明显多于缩宫素＋卡前列素组和卡前列素组（P〈0．01，P〈0．01）；缩宫素组中前置胎盘产妇术后2h出血量明显多于缩宫素＋卡前列素组（P〈0．01）。（5）总出血量≥1000ml的巨大儿产妇12例，双胎产妇11例，前置胎盘产妇8例，无一例切除子宫。（6）副反应发生率缩宫素组为2．6％（4／152），缩宫素＋卡前列素组为11．5％（22／192），卡前列素组为7．0％（9／125），后两组以呕吐为常见，短时间好转。结论卡前列素用于有出血高危因素产妇的剖宫产术可明显减少术中、术后出血量，与缩宫素联合应用效果更好。     

Is rectal misoprostol really effective in the treatment of third stage of labor? A randomized controlled trial

OBJECTIVE: The purpose of this study was to compare misoprostol 600 microg intrarectally with conventional oxytocics in the treatment of third stage of labor. STUDY DESIGN: In a controlled trial, 1606 women were randomly grouped to receive (1) oxytocin 10 IU plus rectal misoprostol, (2) rectal misoprostol, (3) oxytocin 10 IU, and (4) oxytocin 10 IU plus methylergometrine. The main outcome measures were the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 hours after delivery. RESULTS: The incidence of postpartum hemorrhage was 9.8% in the group that received only rectal misoprostol therapy compared with 3.5% in the group that received oxytocin and methylergometrine therapy (P =.001). There were no significant differences among the 4 groups with regard to a drop in hemoglobin concentrations. Significantly more women needed additional oxytocin in the group that received only rectal misoprostol therapy, when compared with the group that received oxytocin and methylergometrine therapy (8.3% vs 2.2%; P <.001). The primary outcome measures were similar in the group that received only rectal misoprostol therapy and the group that received only oxytocin therapy. CONCLUSION: Rectal misoprostol is significantly less effective than oxytocin plus methylergometrine for the prevention of postpartum hemorrhage.     

延长米非司酮配伍米索前列醇序贯用药时间预防流产后出血的 …

目的 探讨米非司酮配伍米索前列醇终止早孕的最佳剂量方案,以预防流产后出血,方法 对１６１２例妊娠≤４９天,要求药物终止妊娠的妇女,按２：１随机分为观察组,对照组。观察组１１８例,米非司酮首次剂量５０ｍｇ,继后每１２ｈ１次,每次２５ｍｇ（共６ｄ）,总剂量３００ｍｇ,于用药第３天晨加用米索前列醇６００μｇ,第４￣６天晨各加服２００μｇ,总量１２００μｇ。对照组４９４例,米非司酮首次剂量５０ｍｇ,继后第     

A double-blind placebo controlled randomised trial of misoprostol and oxytocin in the management of the third stage of labour

Objective To compare oral misoprostol 400 μg with intramuscular oxytocin 10 IU in the routine management of the third stage.
Design Double-blind placebo controlled trial.
Setting Main referral hospital and its associated polyclinics in Accra, Ghana.
Population Four hundred and one low risk women, in the second stage of labour with anticipated vaginal delivery, who entered labour spontaneously.
Methods After delivery of the anterior shoulder of the baby, the women were randomised to receive either: 1. misoprostol 400 μg powder in water orally and 1 mL normal saline intramuscular injection (placebo); or 2. powdered cellulose in water orally (placebo) and 1 mL oxytocin 10 IU intramuscular injection.
Main outcome measures Change in haemoglobin concentration from before delivery to 12 hours postpartum. Secondary outcomes included need for additional oxytocics, blood loss > 500 mL and > 1000 mL, operative intervention for postpartum haemorrhage, and side effects, including nausea, vomiting, diarrhoea, shivering and elevated temperature.
Results Demographic characteristics were similar. There was no significant difference in change in haemoglobin concentration between the two groups (0.60 g/dL for misoprostol and 0.55 g/dL for oxytocin; relative difference 9.6%; 95% CI 20.5–39.6%;   P = 0.54  ). There were no significant differences in secondary outcomes with the exception of shivering, which occurred more frequently in the misoprostol group (22.2% vs 5.7%; relative risk 4.73; 95% CI 2.31–9.68;   P < 0.0001  ).
Conclusions In low risk women oral misoprostol appears to be as effective in minimising blood loss in the third stage of labour as intramuscular oxytocin. Shivering was noted more frequently with misoprostol use, but no other side effects were noted. Misoprostol has great potential for use in the third stage of labour especially in developing countries.     

Sublingual misoprostol versus oxytocin infusion to reduce blood loss at cesarean section.

OBJECTIVE: To compare the effectiveness of sublingual misoprostol administered immediately after delivery of the neonate at cesarean section, with intravenous oxytocin infusion in prevention of uterine atony and thereby reducing blood loss at cesarean section. METHODS: One hundred women with singleton term pregnancy undergoing elective or emergency lower segment cesarean section under spinal anesthesia were included in this study. They were randomly allocated to receive either misoprostol 400 mug sublingually or intravenous infusion of 20 units of oxytocin soon after delivery of the neonate. The main outcome measures were blood loss at cesarean section, change in hemoglobin levels, need for additional oxytocics and drug related side effects. RESULTS: The mean blood loss estimated was significantly lower in misoprostol group compared to oxytocin group (819 ml versus 974 ml; p = 0.004). The number of women who had blood loss exceeding 500 ml and the change in hemoglobin, however, was comparable between the two groups. There was a need for additional oxytocic therapy in 16% and 18% after use of misoprostol and oxytocin respectively (p = 0.673). The incidence of side effects such as pyrexia, shivering and metallic taste was significantly higher in misoprostol group compared to oxytocin group. CONCLUSION: Sublingual misoprostol appears to be as effective as intravenous infusion of oxytocin in reducing blood loss at cesarean section. However, occurrence of transient side effects such as shivering and pyrexia were noted more frequently with the use of misoprostol.