产后出血及其临床救治

产后出血是一种常见的并发症,是产妇发病率和死亡率的主要原因。产后出血有许多潜在的原因,但最常见的是子宫收缩乏力。所有产科工作人员和参与孕产妇保健的工作人员,必须有一个产后出血的预防和管理的明确计划。应当记住:一到位,两个重视,三个正确,提高产后出血救治水平。     

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。     

235例产后出血的临床分析

目的探讨产后出血的高危因素与预防措施,提高产科质量,降低孕产妇的死亡率。方法对2011年1月1日至2013年12月31日在北京市房山区妇幼保健院发生的235例产后出血的患者资料进行回顾性分析。结果剖宫产产后出血率3.15%,阴道分娩产后出血率3.20%,两种生产方式产后出血的率差异无统计学意义(P0.05)。分娩年龄大于35岁的产妇产后出血率高于分娩年龄小于35岁的产妇;孕次大于3次的产妇产后出血率高于孕次小于3次的产妇的出血率;经产妇的产后出血率高于初产妇;胎儿体重大于4 000g的产后出血率高于胎儿体重小于4 000g的产后出血率;妊娠合并症的产后出血率高于无合并症的产后出血率;因巨大儿行剖宫产术中应用缩宫素及卡前列素氨丁三醇(欣母沛)与单纯应用缩宫素比较可降低产后出血的发生率,差异有统计学意义(P0.05)。结论产后出血的受分娩年龄、孕产次、胎儿体重、并发症等因素的影响,加强高危孕产妇管理,正确评估产后出血的高危因素,提前采取预防措施,是降低产后出血的关键。     

产后出血的预防与护理体会

在产科,产后出血仍是最常见.最复杂以至于危及产妇生命的严重并发症。因此重视产后出血特别是在产前、产时和产后做好出血的预防及护理工作尤为重要。     

411例孕产妇产后出血状况的分析

目的通过产妇产前、产后血红蛋白值的变化估计产后的出血量,客观了解产后的出血状况。方法回顾分析上海市长宁区妇幼保健2011年7月连续收治的产妇411例,在产前及产后24h分别抽取肘静脉血0.5ml,测定相应血红蛋白值,分析产后血红蛋白值的变化。根据血红蛋白值下降10g/L估计出血400ml[1]的标准,估计产妇产时出血情况。结果 1产后血红蛋白值下降≥13g/L的产妇26.3%（108/411）,其中顺产组构成比28.8%（74/257）,产钳组构成比73.3%（11/15）;剖宫产组构成比16.5%（23/139）。产后血红蛋白值变化在不同分娩方式组的构成比例上的差异有统计学意义（χ2=32.73,P=0.000）;2本组病例临床上估计的产后出血比例是4.9%,而按血红蛋白下降值标准估计的产后出血比例是26.3%,两者比较差异有统计学意义（χ2值=77.23,P=0.000）。结论剖宫产组的产后出血比例并不高于顺产组;临床估计的产后出血比例明显低于实际产后出血比例;重新定义产后出血的量及产后出血的比例是需要重视、值得研究的问题。     

产后出血的发病率、危险因素和发病趋势变化

产后出血是分娩期严重并发症,是孕产妇死亡的首要原因。由于诊断标准不同,各地报道的产后出血的发生率差异较大。产后出血的危险因素中宫缩乏力是引起产后出血的主要原因,但应注意每一个产妇都有发生产后出血的风险。近年来由于胎盘因素所致的难治性严重产后出血发生率有所增加,需要引起临床医生的重视。     

院前产后出血急救与护理

探讨院前分娩发生产后出血的急救措施与护理方法。方法：对2007年1月至2009年6月院前分娩产后出血9例病例进行回顾性分析。结果：9例产后出血产妇均安全送达医院,经抢救均康复出院。结论：重视产前检查和到正规医院进行分娩,规范应急流程是预防产后出血及提高产后出血抢救成功率的关键。     

产后出血的预防及护理新进展

胎儿娩出后24小时内出血量超过500毫升或以上的诊断为产后出血。产后出血是产妇常见的并发症,通常来势凶猛且发病急促,若不及时诊治就会危及产妇生命健康。产后出血在当前临床孕妇死亡原因中位居首位,为了进一步降低孕妇产后出血死亡率,改善产妇生活及生存质量,对产后出血的产妇给予有效的预防及护理措施尤为关键。对此,本文就产后出血的预防及护理展开讨论,探讨和分析当前临床针对产后出血给予的预防及护理措施,旨在进一步提高产后出血的临床护理水平,保证产妇生命健康。     

背带式缝合子宫捆绑术在产后出血中的应用

产后出血是产科常见的分娩期并发症,是产妇死亡的主要原因之一.近年来,我国孕产妇死亡率虽有下降,但产后出血在全国仍居产妇死亡的第1位.而宫缩乏力性产后出血又居产后出血的首位.因此,及时有效地处理宫缩乏力性产后出血,对降低产妇死亡极为关键.     

益母草注射液联合缩宫素预防剖宫产产后出血

近年剖宫产率有上升趋势,预防剖宫产产后出血备受产科医师重视.我院近2年对有刮宫产产后出血高危因素的产妇,术中、术后使用益母草注射液联合缩宫素预防产后出血,效果良好,现报告如下.     

全球产后出血指南异同

产后出血是全球孕产妇死亡的首要原因,产后出血的诊断和治疗指南对规范产后出血的临床管理及降低孕产妇死亡率意义重大。文章对我国产后出血指南及全球其他国家主要产后出血指南的推荐进行对比,希望进一步提高产科医生对产后出血的重视程度。     

产后出血的保守性手术治疗

产后出血是分娩期常见而且严重的并发症,在药物和子宫按摩不能控制出血时,需采取手术干预。保守性手术是指保留子宫的手术方法,包括血管结扎、宫腔填塞压迫止血、子宫压迫缝合等。B-Lynch缝合技术在产后出血的保守性手术治疗中具有里程碑式的意义,并且由此改良出多种子宫压迫缝合方法。这些技术各有利弊和不同的适应证,根据产后出血的不同原因选择合适的保守性手术方式,才能达到良好止血和减少并发症的目的。     

如何规范产后出血的药物治疗

产后出血（postpartum hemorrhage）是导致孕产妇死亡的首要原因。引起产后出血的原因分别为子宫收缩乏力、胎盘因素、软产道裂伤及凝血功能障碍。产后出血的病因治疗是最根本的治疗,是产后出血救治成功的关键。产后出血的药物治疗主要是针对子宫收缩乏力宫缩剂的治疗。缩宫素为一线用药,当单独手法按摩子宫和缩宫素不能达到止血目的时,可以考虑使用卡贝缩宫素、卡前列素氨丁三醇或卡前列酸栓。在没有注射用宫缩剂或注射用宫缩剂使用禁忌时可以考虑使用米索前列醇。当药物加强宫缩治疗无效时应注意不同药物的起效时间及持续时间。此外,一方面要重新核对有无合并其他原因所致产后出血;另一方面应及时采用必要的进一步治疗如宫腔填塞或子宫动脉栓塞等。     

Postpartum hemorrhage

Postpartum hemorrhage (PPH) is the leading cause of death related to pregnancy worldwide. Most deaths resulting from PPH are preventable. Physicians, nurses, midwives, and other birth attendants should be aware of the risk factors for PPH and be trained adequately in the preventive measures and management strategies for this pregnancy complication. Newer, less invasive technologies such as embolization may improve outcomes with PPH. Reducing the incidence of PPH and the mortality resulting from the condition should be a key goal of obstetrics services worldwide. This article focuses on the etiology, prediction, prevention, and management of PPH.     

Reducing postpartum hemorrhage in Africa.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in sub-Saharan Africa. This is being addressed by leading professional organizations, which point to the importance of a skilled attendant at birth. But they also emphasize that the active management of the third stage of labor is proven to reduce the incidence of PPH. In low-income settings, the prostaglandin misoprostol should be considered as it is low-cost, stable at room temperature and easy to administer.     

再谈产后出血患者出血量的计算

产后出血(postpartum hemorrhage)是产科最常见、最凶险的并发症之一,是导致全球孕产妇死亡的主要原因。准确地预估出血量,对临床上选择何种方法预防和治疗产后出血具有重要的指导意义。临床上常用的方法有：目测法、面积法、称重法、血红蛋白测定法以及休克指数等方法,近年又有学者研究发明了一种新型直观、较为精确的容量袋法。     

Women's descriptions of postpartum health problems: preliminary findings from Matlab, Bangladesh

Complications of childbirth kill more than 500,000 women each year. Postpartum hemorrhage (PPH) is the leading cause of death. Because nearly half the women who give birth at home in developing countries are cared for by unskilled attendants, it is critical to understand how women and their caregivers recognize bleeding and decide to seek help when needed. Using an approach that combined systematic qualitative data collection and multivariate analysis, we identified local cultural theories that women and traditional birth attendants in rural Bangladesh use to recognize and care for postpartum problems, including PPH. These preliminary findings will be used to further explore cultural norms related to PPH and their possible modes of transmission. The overall approach may be used to develop or improve birth preparedness and complication readiness, a core global safe motherhood intervention.     

Postpartum hemorrhage prevention: a case study in northern rural Honduras

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Safe Motherhood policies have been directed towards the reduction of PPH by recommending active management of third-stage labor as the standard of care. One component of active management involves routine use of a uterotonic agent within 1 minute of the delivery of the baby. A case study at Clínica Materno-Infantil, a free-standing public birth center in Honduras, is presented, focusing on methods to reduce PPH. The nursing staff was trained to estimate blood loss and in methods to manage PPH, including elements of active management of the third stage of labor. Medical records were reviewed and an analysis of PPH management compared to estimated blood loss (EBL) was conducted. There was no significant correlation between PPH management techniques and EBL (r = .060; P = .368). There was a statistically significant (P < .001) correlation between oxytocin administration and lower EBL (r = -.232), indicating that there was less blood loss when oxytocin was administered. At Clínica Materno-Infantil, routine use of a uterotonic agent appears beneficial and further implementation of active management of the third stage of labor appears warranted.