浅谈米索前列醇在预防和控制产后出血中的临床应用

产后出血是一种产科常见并发症,是引发产妇死亡的主要原因。产后出血有许多潜在的原因,最常见的是子宫收缩乏力。预防和控制产后出血是所有产科工作人员和参与孕产妇保健的工作人员必修科目。我院从2009年对存在产后出血高危因素的孕产妇产后给予米索前列醇舍下含化,明显降低了产后出血的发生率。引起孕产妇死亡第一位的原因是产后出血,特别是在中西部欠发达地区,产后出血是孕产妇死亡的主要原因之一,因此预防和控制产后出血犹显重要。     

子宫动脉下行支及宫旁血管钳夹术治疗宫缩乏力性产后出血的研究

产后出血最常见的原因是宫缩乏力,80%发生在产后2h内,通常用宫缩剂加按摩子宫等方法来促进子宫收缩治疗产后出血,但有时效果不理想,近年有许多治疗产后出血的报道.我们采用卡前列甲酯栓防治产后出血,产后出血病率减少.     

晚期产后大出血的介入治疗

晚期产后大出血为妇产科较为常见的疾病 ,也为产科的严重并发症之一 ,是产妇死亡的主要原因之一。晚期产后出血是指分娩 2 4小时后至产褥期内发生的子宫大量出血或异常阴道出血。据报道晚期产后出血的发生率为0 2 8% [1] ,本院曾统计 31 8万例中 ,晚期产后出血 6 6例 ,其发生率为 0 2 1% ,与文献报道大致相符。　　晚期产后出血的主要原因是胎盘残留和 (或 )胎膜残留、宫腔感染、胎盘附着面的复旧不良及剖宫产术后子宫切口感染、不愈合导致晚期产后大出血 ,同时产道损伤也是导致晚期产后大出血的原因之一[2 ] 。在本院统计的晚期产后出血…     

产后出血47例临床诊治分析

目的:探讨产后出血的发生原因,总结临床治疗方法,以为日后对产后出血治疗提供参考。方法:回顾性分为我院2009年1月至2010年9月收治的47例产后出血患者的临床诊治方法,分析患者出现产后出血的原因。结果:47例患者中,有31例患者为子宫收缩乏力,9例患者为胎盘因素,5例患者为软产道裂伤,2例患者为凝血功能障碍。临床治疗可采用子宫按摩、注射催产素、修补软产道、宫腔填塞、手术等多种方法。结论:产后出血是临床较为常见的一种产后并发症,需要医生对患者提高注意,早期诊断,并给予正确的治疗。     

产后子宫收缩乏力性出血的诊断与治疗

产后出血是产科常见而又严重并发症之一,是引起产妇死亡四大疾病中的首要原因.在产后出血病例中,最常见的原因是子宫收缩乏力性出血,约占产后出血总数的70%～75%亦有报道高达90%者.可见预防和治疗产后子宫收缩乏力性出血是非常重要的.1 产后富缩乏力性出血的原因任何影响子宫肌纤维正常收缩和缩复功能的因素,都会引起子宫收缩乏力性出血.1.1 全身性因素:机体有慢性疾病,特别是肝病和血液系统疾病;产程延长或难产,产妇体力衰竭没有很     

产后出血的预防及处理

产后出血是常见的妇产科疾病之一,是指胎儿娩出之后24小时内,阴道的血流量超过500ml。产后出血是导致孕产妇死亡的重要原因,占死亡率的49．9％,是妇产科临床非常危险的并发症。目前,中国以及多个发展中国家的产后出血发生率在全世界排名前列。因此,做好产后出血的预防和处理工作很重要,积极地预防和恰当的产后处理可以大大减少产后出血的发生率,降低孕产妇的死亡率,提高产科的医护质量。本文就产后出血的预防和处理做一综述。     

重组活化因子Ⅶ在难治性产后出血中的应用

产后出血是全球最常见孕产妇死亡原因之一。重组活化因子Ⅶ(rFⅦa)已成功应用于有凝血因子Ⅷ或Ⅸ抑制物的血友病患者,并用于其他凝血酶生成障碍性出血性疾病患者。近年也有研究表明,rFⅦa在治疗外伤、外科相关事件导致的严重出血,甚至在妇产科出血等非血友病的出血方面起到更广泛作用。现就rFⅦa在难治性产后出血中的临床应用进展进行综述。     

重组活化因子Ⅶ在难治性产后出血中的应用

产后出血是全球最常见孕产妇死亡原因之一。重组活化因子Ⅶ（rFⅦa）已成功应用于有凝血因子Ⅷ或Ⅸ抑制物的血友病患者，并用于其他凝血酶生成障碍性出血性疾病患者。近年也有研究表明，rFⅦa在治疗外伤、外科相关事件导致的严重出血，甚至在妇产科出血等非血友病的出血方面起到更广泛作用。现就rFⅦa在难治性产后出血中的临床应用进展进行综述。     

产后出血的预防

胎儿娩出后24h内出血量超过500ml者称产后出血。产后出血是产科常见的严重并发症之一，为我国目前孕产妇死亡的首要原因。引起产后出血的原因主要有子宫收缩乏力、胎盘因素、软产道裂伤和凝血功能障碍。要想做到有效地预防产后出血，应从产前、产时、产后三方面着手。     

卡孕栓预防剖宫产术后出血的临床观察

产后出血是产科临床常见的严重并发症之一，是当前我国孕产妇死亡的首位原因。在产后出血常见四大原因中，子宫收缩乏力是最常见的病因，占产后出血总数的70％～80％，因此积极防治子宫收缩乏力性出血是降低孕产妇死亡率的关键。我院将卡孕栓（PGF2α）用于具有产后出血高危因素的产妇，在剖宫产术中应用卡孕栓联合缩宫素预防产后出血报道如下。     

阴道分娩及剖宫产产后出血预警及防范

产后出血是产科常见且严重的并发症之一,是产妇死亡的首要原因。产后出血患者通常在产前即存在一种或多种高危因素,引起产后出血主要包括子宫收缩乏力、胎盘因素、软产道损伤、凝血功能异常四大因素。因此,所有产科工作者都应当重视防治产后出血,及早发现高危因素,及时处理,从而降低产后出血的发生率。     

Trends in conservative procedures and peripartum hysterectomy rates in severe postpartum haemorrhage

Objective: The objective of this study is to explore whether increase in use of second-line conservative surgical procedures will alter the rate of peripartum hysterectomies in management of severe postpartum haemorrhage (PPH).

Methods: This is a retrospective cohort. All pregnant patients with gestation >?=?28 weeks with severe PPH (>?=?1.5?L) within 72?h of delivery from year 2000 to 2015 (16-year period) in an obstetric training unit was recruited. Basic patient anthropometric characteristics and the main causes for PPH were calculated. The incidence of any second-line conservative surgical procedures and peripartum hysterectomies were evaluated. The total number of patients in each category was then stratified into four 4 years-intervals (4 quadrennium) to compare trends.

Results: The incidence of severe PPH gradually increased over the study period (lowest 0.21% in 2002 to 0.76% in 2015) (p?p?p?=?.04).

Conclusions: Despite the increasing trends in PPH, the increasing utilisation of second-line conservative surgical procedures in severe PPH should be able to reduce the need for peripartum hysterectomy.     

Medical prevention and treatment of postpartum hemorrhage: a comparison of different guidelines

Background

Postpartum hemorrhage (PPH) remains a common cause of maternal mortality worldwide, mainly caused by uterine atony. Medical intervention plays an important part in prevention and therapies of PPH. Prophylactic interventions include the use of uterotonic drugs. We elaborated the consistency of national and international guidelines on those medical approaches.

Materials and methods

Medical approaches in PPH were extracted from recent publications. Furthermore, the current guidelines of the World Health Organization, the FIGO and of the American, British, Canadian and German Societies of Obstetricians and Gynecologists on PPH were analyzed.

Results

Oxytocin is considered as therapy of first choice. However, the examined guidelines fail to give unequivocal recommendations on further uterotonics in PPH, which may partially be attributed to differing publication dates of the guidelines.

Conclusion

International guidelines on PPH are characterized by differing recommendations. However, recent publications suggest that adhering to local guidelines significantly reduces the prevalence of severe PPH.     

Postpartum hemorrhage: a prospective, comparative study in Angola using a new disposable device for oxytocin administration

BACKGROUND: Postpartum hemorrhage (PPH) is the single most common cause of maternal death in the world, and oxytocin is known to be effective for its prevention and treatment. The use of syringes can be problematic in areas affected by HIV. The aim of this study was to introduce Uniject (a new disposable device for administration of 10 IU oxytocin) as part of active management of the third stage of labor (AMTL) and try to reduce PPH. METHODS: A prospective, comparative study was performed between March 1998 and May 2000 in Luanda. Seven hundred and eighty-two parturient women with physiological management were compared to 814 with AMTL. Postpartum lost blood was collected using a plastic sheet during labor and a bucket placed under a cholera bed for 2 h postpartum. Student's t-test and chi(2) test were used. RESULT: PPH was reduced from 40.4 to 8.2% and severe PPH (> or =1000 ml) from 7.5 to 1% in the AMTL group (P < 0.001). CONCLUSIONS: Uniject was well tolerated and offers an alternative for oxytocin administration. AMTL should be implemented also in resource-poor settings as a routine management to reduce PPH.     

阴道分娩产后出血原因识别及防治

产后出血是产妇死亡的主要原因,阴道分娩时软产道撕裂是导致产后出血的重要环节,应当及时识别,认真处理,积极防控。应当记住:失血量评估要到位;重视高危产妇,重视团队协作;正确按摩子宫,正确使用药物,正确选择手术。     

Medical and Conservative Surgical Management of Postpartum Hemorrhage

Massive postpartum hemorrhage (PPH) is a major cause of maternal mortality in the United Kingdom and worldwide. Life-threatening PPH occurs with a frequency of I in 1000 deliveries in the developed world. In the latest triennial Why Mothers Die: Confidential Enquiries into Maternal Deaths in the United Kingdom (1997–1999), PPH was the fifth most common cause of maternal mortality. In this review, we discuss the role of medical management in primary PPH and the use of the “tamponade test” when such management fails. The less radical surgical options discussed include uterine compression sutures, uterine or internal iliac artery ligation, and arterial embolization, all of which have the advantage of potentially preserving reproductive function. Radical surgical options, including subtotal or total hysterectomy, are not discussed in this review. A systematic or algorithmic method of tackling the problem is described. The suggested management approach is likely to reduce maternal morbidity from bleeding, hysterectomies, and maternal deaths.     

Concomitant and repeated happenings of complications of the third stage of labour

Summary. Complications of the third stage of vaginal delivery have been studied among 36312 women in Aberdeen between 1967 and 1981. There was no change in the incidence of retained placenta (RP), but there was a secular increase in postpartum haemorrhage (PPH). Postpartum haemorrhage was three times more common when there was a retained placenta. PPH was commoner in primiparae and after induced labour. The main focus of this paper is on the analysis of the risks of repetition among 6615 women with two or three live births between 1967 and 1980. A history of PPH and/or RP increased the relative risks of PPH and/or RP in a subsequent birth by between two and four times compared with women without such a history. The risk of repetition was increased if the subsequent birth was induced, or if there was an intervening abortion. Nevertheless. only a minority of the multiparae who experienced a third stage complication had a previous history of such a complication.     

Use of second-line therapies for management of massive primary postpartum hemorrhage

Objective

To determine rates of use and success of second-line therapies for massive primary postpartum hemorrhage (PPH).

Methods

A retrospective cohort study was conducted among 91 women who gave birth at Kwong Wah Hospital, Hong Kong, between January 1, 2006, and December 31, 2011. Inclusion criteria were gestational age of at least 24 weeks and massive PPH (defined as blood loss ≥ 1500 mL within 24 hours after birth). Second-line therapies assessed were uterine compression sutures, uterine artery embolization, and balloon tamponade after failure of uterine massage and uterotonic agents to stop bleeding.

Results

The rate of massive PPH was 2.65 per 1000 births. Second-line therapies were used among 42 women with PPH, equivalent to a rate of 1.23 per 1000 births. Only 21.4% of the women who received second-line therapies required rescue hysterectomy. A rising trend was observed for the use of second-line therapies, whereas the incidence of rescue hysterectomy and estimated blood loss were found to concomitantly decrease.

Conclusion

Increasing use of second-line therapies among women with massive PPH was associated with a decreasing trend for rescue hysterectomy. Obstetricians should, therefore, consider all available interventions to stop PPH, including early use of second-line options.     

Concomitant and repeated happenings of complications of the third stage of labour

Complications of the third stage of vaginal delivery have been studied among 36 312 women in Aberdeen between 1967 and 1981. There was no change in the incidence of retained placenta (RP), but there was a secular increase in postpartum haemorrhage (PPH). Postpartum haemorrhage was three times more common when there was a retained placenta. PPH was commoner in primiparae and after induced labour. The main focus of this paper is on the analysis of the risks of repetition among 6615 women with two or three live births between 1967 and 1980. A history of PPH and/or RP increased the relative risks of PPH and/or RP in a subsequent birth by between two and four times compared with women without such a history. The risk of repetition was increased if the subsequent birth was induced, or if there was an intervening abortion. Nevertheless, only a minority of the multiparae who experienced a third stage complication had a previous history of such a complication.