产后即时徒手宫腔探查减少产后出血

目的　探讨产后即时徒手宫腔探查 (俗称指搔 )对减少产后出血的临床效果及可行性。　方法　选择足月妊娠 ,阴道分娩的单胎 ,头位初产妇 2 0 0例 ,随机分为探查组和对照组各 10 0例 ,探查组产后胎盘娩出后常规做徒手宫腔探查 ,对照组不做徒手宫腔探查 ,对比研究 2组的产后出血量 ,子宫复旧状况 ,产褥病率及产褥感染情况。　结果　胎盘娩出即时出血量探查组 (136 3± 12 2 0 )ml,对照组 (138 5± 118 0 )ml,2组差异无显著性 (P >0 0 5 ) ;产后 2h的出血量探查组 (2 98 0±15 4 2 )ml,对照组 (30 6 0± 14 8 5 )ml,2组差异无显著性 (P >0 0 5 ) ;产后 2 4h的出血量探查组(342 2± 16 8 7)ml,明显少于对照组 (388 5± 176 4 )ml,(P <0 0 1) ;产后 2 4h出血≥ 5 0 0ml发生率探查组 11 0 % (11/ 10 0 )低于对照组 2 4 % (2 4 / 10 0 ) (P <0 0 5 ) ;晚期产后出血探查组发生 1例 ,为蜕膜感染 (刮宫病检 )所致 ,对照组 2例均为胎盘、胎膜残留 ;产褥病率探查组 12 0 % (12 / 10 0 )明显高于对照组 3 0 % (3/ 10 0 ) (P <0 0 1) ;子宫复旧情况及产褥感染率 2组比较差异均无显著性(P >0 0 5 )。　结论　产后徒手宫腔探查有利有弊 ,不宜作为产后常规操作 ,但对有明显胎盘及胎膜残留者不失为一种简便、

Application of postpartum uterine curretage in the postpartum hemorrhage prophylaxis

Objectives To investigate the efficacy and safety of postpartum curettage in reducing postpartum blood loss. Methods Two hundred primigravida with term singleton pregnancy,vertex presentation,spontaneous delivery were enrolled in this study.They were randomly divided into two groups:100 received curettage after placenta delivery as a study group and 100 as a control group.Postpartum blood loss,uterine involution,puerperal infection and postpartum morbidity were observed. Results There were no significant differences in postpartum blood loss within 2 hours (P>0 05)between two groups,but less postpartum blood loss within 24 hours (P<0.01),less postpartum hemorrhage rate (P<0.05),and less late postpartum hemorrhage rate were observed in study group.Higher puerperal mobidity was found in study group (P<0.01),There were no significant difference in uterine involution (P>0 05) and rate of puerperal infection (P>0 05) between these two groups. Conclusion A routine postpartum uterine curettage is not justified unless in cases of placental retained were suspected.