改良剖宫产术对预防产后出血的研究

目的:探讨减少剖宫产术中出血的方法。方法:实验组剖宫产术中在胎儿娩出后及胎盘娩出前用纱垫填压子宫下段切口处,同时应用缩宫素及/或前列素等常规加强宫缩的方法,不急于人工剥离胎盘,而于切口一侧角提前缝合2~3针,等待胎盘自然剥离后继续缝合至对侧角。对照组采用传统的方法按摩宫底或经人工剥离娩出胎盘后再行缝合子宫切口。缩宫素的应用同实验组。结果:实验组1 500例子宫下段式剖宫产术中平均出血279 m l,产后出血率为16.6%。对照组1 100例子宫下段式剖宫产术中平均出血量为352 m l,产后出血率为19.3%。两组比较差异有显著意义(P<0.01)。结论:剖宫产术中胎盘娩出前填压子宫下段结合提前缝合子宫切口可减少出血量,降低产后出血发生率。

Study of modified hysterotokotomy on prevention of postpartum hemorrhage

Objective:To study the approach for reducing postpartum hemorrhage.Methods:During hysterotokotomy,in experimental group,between after fetal expulsive and before placental expulsive,incision of lower uterine segment were filled with gauze packing and sutured for 2～3 needles at one side of the segment,and sutured again toward the other side after separation of placenta,at the same time used uterine contraction drugs such as oxytocin,prostaglandin;in control group,traditional hysterotokotomy were used for instance incision of lower uterine segment were sutured after manual removal of placenta or massage fundus of uterus,and used the same uterine contraction drugs as the experimental group.Results:In 1 500 cases of experimental group,their average bleeding is 279 ml and their hemorrhage rates is 16.6%,in 1 100 cases of control one,352 ml and 19.3% respectively,there are significant differences among them(P<0.01).Conclusion:The modified hysterotokotomy e.g.during hysterotokotomy,before placental expulsive,incision of lower uterine segment were filled with gauze packing and sutured,can reduce bleeding quantity and cut down postpartum hemorrhage rates.