米索前列醇直肠给药预防剖宫产术后出血

剖宫产术后出血在临床上较常见。2003年6～12月，我们对153例行剖宫产术分娩者，采用米索前列醇直肠给药预防剖宫产术后出血，疗效满意。现报告如下。     

米索前列醇治疗产后出血的疗效观察

目的探讨米索前列醇舌下给药对择期剖宫产术后阴道出血的影响。方法对28例择期剖宫产产妇在术后即舌下置入米索前列醇400μg,30例同期剖宫产产妇在术后应用5%葡萄糖500ml加入缩宫素20u静脉点滴,观察术后出血量及产妇血压的变化。结果米索前列醇组24h的出血量较缩宫素组减少,差异有统计学意义(P<0.05),米索前列醇组出血发生率低于缩宫素组,差异有统计学意义(P<0.05)。结论米索前列醇舌下给药预防择期剖宫产术后出血疗效显著,简单易行。     

米索前列醇联合催产素预防产后出血的疗效观察

目的观察米索前列醇联合催产素预防产后出血的效果。方法将我院收治的120例产后出血患者随机分为对照组和观察组,每组各60例,对照组采用催产素治疗,观察组采用米索前列醇联合催产素治疗,比较两组治疗效果及不良反应发生情况。结果观察组第三产程时间短于对照组,差异有统计学意义（P〈0.05）。观察组产后2h出血量低于对照组,差异有统计学意义（P〈0.05）。两组患者治疗过程中,均未见明显不良反应发生。结论米索前列醇联合催产素与单用催产素组相比,产妇出血量明显减少,第三产程时间明显缩短,无明显不良反应发生,值得临床推广应用。     

米索前列醇预防剖宫产术后出血的疗效观察

目的观察米索前列醇预防剖宫产术后出血的疗效。方法选择200例剖宫产者,随机分为米索前列醇组(简称米索组)和催产素组,每组各100例。米索组术后(即手术结束后)予米索前列醇400 μg纳肛,催产素组于术后立即给予催产素20 U+5%葡萄糖注射液500 ml静脉点滴,分别观察两组产后2 h和 24 h出血量、用药后产妇血压及副反应的差异。结果术后2 h出血量,米索组显著少于催产素组(P<0.05);两组术后血压变化差异无统计学意义(P>0.05);副反应两组比较,差异无统计学意义(P>0.05)。结论米索前列醇预防剖宫产术后出血效果较催产素好。     

米索前列醇预防产后出血的疗效观察

目的观察米索前列醇预防产后出血的临床效果。方法选择无合并症的正常足月妊娠阴道分娩的产妇280例。随机分为两组,均于胎儿娩出后立即给药,A组肛门塞入米索前列醇200μg,B组肌肉注射缩宫素20U,测量产后2h出血量及用药后的不良反应。结果实验组产后2h出血量较对照组明显减少,差异有统计学意义。结论米索前列醇具有比缩宫素更强的缩宫作用,临床应用安全有效。     

米索前列醇宫腔内给药联合缩宫素预防剖宫产后出血的疗效观察

目的探讨米索前列醇宫腔内给药联合缩宫素预防剖宫产后出血的疗效。方法将2014-05~2017-05在该院行剖宫产分娩的妇女300例按随机数字表法分为两组各150例,对照组待胎儿娩出后宫体注射缩宫素10 U,同时以缩宫素20 U加入500 ml葡萄糖中静脉滴注;研究组则宫体注射缩宫素10 U,并将米索前列醇片0.4 mg置于宫腔内,比较两组产妇术中出血量、术后2 h累计出血量、术后24 h总出血量、产后出血发生情况、第三产程时间及产妇不良反应发生情况。结果研究组术中出血量、术后2 h出血量、术后24 h出血量均明显少于对照组(P0.05)。研究组产后出血发生率明显低于、第三产程时间明显短于对照组(P0.05)。两组均未出现其他明显的不良反应。结论剖宫产术中米索前列醇宫腔内给药联合缩宫素预防产后出血的疗效显著,安全性高,值得临床推广应用。     

米索前列醇预防产后出血临床观察

为探讨米索前列醇预防产后出血的疗效 ,我们对部分住院分娩的第一胎单胎足月顺产产妇给予米索前列醇预防产后出血 ,并进行了对照观察。现报告如下。临床资料 :选择 2 0 0 0年 1月至 2 0 0 1年 10月在我院住院分娩的第一胎单胎足月顺产产妇 183例 ,随机分为米索前列醇组 6 1例 ,催产素组 5 8例 ,米索前列醇 +催产素组 6 4例。产后出血采用《妇产科学》第四版的诊断标准。研究方法 :在胎儿前肩娩出后 ,米索前列醇组立即口服米索前列醇 4 0 0μg,催产素组立即肌注催产素 2 0 U ,米索前列醇+催产素组立即口服米索前列醇 4 0 0 μg,并肌注催产素…     

米索前列醇预防产后出血的临床研究

将１３０例足月妊娠经阴分娩者随机分为两组，研究组于第二产程末口服米索前列醇（ＰＧＥ１），胎儿娩出后辅以催产素；对照组仅于胎儿娩出后单用催产素。结果对照组有３例发生产后出血，研究组无产后出血者，且其产后出血量明显少于前者（Ｐ＜０．０１）。表明第二产程末口服ＰＧＥ１预防产后出血方便、经济、安全、无不良反应，与催产素并用可作用互补、增强疗效。     

米索前列醇预防产后出血90例效果观察

为探讨一种简便、安全、有效防治产后出血的方法，1999年3月至2002年12月，我们对足月妊娠经阴道分娩者具有产后出血高危因素的产妇，应用米索前列醇预防产后出血，效果满意。现报告如下。     

米索前列醇预防产后出血效果观察

20 0 0年 3月至 2 0 0 1年 5月 ,我们对 10 0例足月妊娠者于胎头着冠后一次性肛内装置米索前列醇 4 0 0μg预防产后出血 ,经临床观察 ,效果显著。现报告如下。临床资料　选择同期单胎头位足月妊娠阴道分娩的初产妇 2 0 0例 ,无前列腺素应用禁忌 ,无内外科合并症和产科并发症。随机分为米索组和对照组 ,各为 10 0例。两组的年龄、体重、孕次、分娩孕周、第一产程和第二产程时间、会阴缝合时间和新生儿体重方面均无明显差异 (P>0 .0 5 ) ,具有可比性。给药方法　米索组在胎头着冠后一次性经肛门放置米索前列醇 4 0 0 ug(2片 ) ,对照组放置维…     

产后出血预测评分及防治机制在预防剖宫产宫缩乏力性出血中的效果分析

目的分析产后出血预测评分及防治机制在预防剖宫产宫缩乏力性出血中的效果。方法选取2013-04~2014-12该院收治的310例剖宫产宫缩乏力性出血产妇作为研究对象。根据患者临产的情况进行产后出血预测评分,按分数进行分组,低危组(0~4分)113例,中危组(5~7分)115例,高危组(8~10分)82例。三组产妇在进行剖宫产胎儿分娩出的前3 min给予卡孕栓,其中高危组在胎儿分娩后给予卡贝缩宫素静脉注射,比较三组产妇各阶段出血量。结果高危组和中危组术中出血量、术后2 h出血量、24 h出血量高于低危组(P0.05),但高危组和中危组之间差异无统计学意义(P0.05)。结论产后出血预测评分对产后出血预测存在一定的可靠性,高危产后出血产妇在剖宫产过程中除给予常规的防治措施之外,再给予卡贝缩宫素,可减少产妇术后出血量,具有一定的临床应用价值。     

剖宫产产后出血相关因素分析

目的探讨剖宫产产后出血的相关因素,为其防治提供参考。方法选择剖宫产产后出血产妇118例（出血组）,并与同期年龄相仿、无剖宫产后出血的产妇118例（对照组）对照。收集两组有关的临床资料（包括年龄、职业、孕产次、孕周等）,通过χ2检验比较两组暴露因素的构成差异,采用多因素Logistic回归分析筛选剖宫产产后出血的高风险独立相关因素。结果单因素分析显示,出血组的脑力劳动、孕周〈37周、胎盘异常（胎盘粘连或植入）、择期剖宫产、宫缩乏力、子宫裂伤、妊娠期高血压疾病、新生儿体重≥4.0kg的构成比高于对照组（P=0.001～0.045）。多因素Logistic回归分析显示,宫缩乏力（OR？=5.367;95%CI：2.451～11.755）和子宫裂伤（OR？=5.778;95%CI：1.963～17.009）是剖宫产产后出血的高风险独立相关因素。结论宫缩乏力和子宫裂伤是剖宫产产后出血的高风险因素,应加强防护。     

益母草注射液联合缩宫素预防剖宫产产后出血及促进子宫复旧的临床研究

目的：探讨益母草注射液联合缩宫素预防剖宫产产后出血及促进术后子宫复旧效果。方法选择孕龄＞28周行剖宫产患者360例,分为治疗组180例,用益母草注射液联合缩宫素治疗;对照组180例,单纯用缩宫素治疗。观察两组产妇术中及术后不同时段出血量、产后出血例数、不同时段子宫收缩情况、子宫复旧情况,较术前血红蛋白下降程度等。结果治疗组各个时段出血量少于对照组,差异有统计学意义（P＜0．05）。治疗组各个时段子宫收缩情况均好于对照组,其中术中、术后2 h、6 h差异有统计学意义（ P＜0．05）。两组术后3 d、5 d子宫底下降幅度比较差异有统计学意义（ P＜0．05）。两组术后48 h与产前血红蛋白下降程度＜1 g／L、1-2 g／L、＞2 g／L比较差异有统计学意义（ P＜0．05）。结论益母草注射液联合缩宫素预防剖宫产产后出血及促进子宫复旧疗效确切,可作为防治产后出血和子宫复旧的优选治疗方案。     

Timing of postpartum enoxaparin administration and severe postpartum hemorrhage.

The appropriate time to restart anticoagulation in the postpartum period is not known. The purpose of the present study was to determine whether the timing of postpartum enoxaparin influences hemorrhagic outcomes. A total of 95 women were treated with peripartum enoxaparin and compared with 303 consecutive deliveries where anticoagulation was not administered. The overall rate of severe postpartum hemorrhage did not differ significantly for women treated with peripartum enoxaparin (4.2%) versus nonanticoagulated control individuals (2.0%, P = 0.40) nor for the subgroup of women who underwent vaginal delivery (3.6 versus 1.4%, P = 0.55) or cesarean section (5.1 versus 3.4%, P = 0.98). We did not observe any severe hemorrhagic events attributable to administration of postpartum enoxaparin. The first dose of enoxaparin was administered less than 24 h following delivery in 75% of vaginal deliveries and in 49% of cesarean sections where enoxaparin was given in the postpartum period. Two incisional hematomas were observed in the group of women who received enoxaparin within 24 h following cesarean section. Severe postpartum hemorrhage is an infrequent complication when enoxaparin is administered to hemostatically intact women between 5 and 24 h following a vaginal delivery or 12-36 h following cesarean section.     

Effect of blood transfusion during cesarean section on postpartum hemorrhage in a tertiary hospital over a 4-year period

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and death worldwide. The history of cesarean section and the occurrence of placenta previa were significantly associated with the increase in blood transfusion. Therefore, to prevent PPH, it is important to understand the effect of blood transfusion during cesarean section on postpartum hemorrhage. The purpose of this study is to determine the cause of blood transfusion during cesarean section, especially large amounts of blood transfusion, and to take measures to reduce the blood demand caused by PPH with limited blood supply.This study was a retrospective study of patients who underwent blood transfusion during cesarean section in Qilu Hospital of Shandong University (China) from January 2013 to December 2016. Red blood cell infusion ≥10 U during cesarean section was defined as massive blood transfusion. The study collected the demographics of pregnant women, obstetric characteristics and reasons for blood transfusions, as well as blood components and blood transfusion results. Multivariate regression analysis was performed for evaluating the risk factors of PPN.From 2013 to 2016, a total of 587 patients received blood transfusions during cesarean section. The proportion of women receiving blood transfusion during cesarean section increased (from 3.21% to 7.40%, P < .001). The history of cesarean section (P = .005) and the occurrence of placenta previa were positively correlated with the increase in blood transfusion (P = .016). There were 72 cases of massive blood transfusion, accounting for 12.27% of blood transfusion patients. Among mass blood transfusions, 93.1% of cases had prior cesarean delivery, and placenta previa accounted for 95.8%. 19.4% of patients receiving massive blood transfusions underwent hysterectomy. There was no significant difference in maternal BMI and gestational age between the mass blood transfusion group and the non-mass blood transfusion group.From 2013 to 2016, the demand for blood transfusion, especially the demand for massive blood transfusion, increased. Repeated cesarean section and placental previa combined with uterine scar are positively correlated with increased blood transfusion. Reducing the initial cesarean section should help reduce the massive blood transfusion caused by placenta previa with a history of cesarean section.     

剖宫产术后再次妊娠者阴道分娩与再次剖宫产的对照分析

目的 探讨剖宫产术后再次妊娠分娩方式的选择.方法 随机抽取2008-01～2009-09收治剖宫产术后再次妊娠孕妇156例,对其分娩方式、分娩结局及医疗费用进行回顾性分析评价.结果 156例剖宫产术后再次妊娠者,行再次剖宫产(RCS)125例(其中择期剖宫产112例,阴道试产改行剖宫产13例),占80.13%;阴道试产(TOL)44例,占28.21%,试产成功率为70.45%;阴道分娩(VBAC)31例,占19.87%.RCS组较VBAC组出血量大,分别为(175.7±4.0)ml和(85.5±8.5)ml,平均住院天数RCS组较VBAC组相对较长,分别为(8.20±1.58)d和(3.20±0.42)d,医疗费用RCS组较VBAC组为高.结论 有剖宫产史再次妊娠者,不一定选择剖宫产作为绝对指征,如无试产禁忌者可在严密监护下先行阴道试产.