Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergometrine in the management of the third stage of labor
Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergometrine in the management of the third stage of labor
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DOI：
10.1080/00016340600756912
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发表时间：
2006-11-01
影响因子：
4.3
通讯作者：
Maruo, Takeshi
中科院分区：
文献类型：
--
作者：
Fujimoto, Miki;Takeuchi, Kyousuke;Maruo, Takeshi
目标。旨在确定静脉注射催产素与静脉注射甲基麦角新碱预防产后出血（PPH）的功效，以及第二产程结束时与第三产程后给药的意义。方法。进行了一项前瞻性研究：对 438 名单胎妊娠和阴道分娩的两个主要组（催产素组和甲基麦角新碱组）进行了为期 15 个月的研究。这两组又分为三个亚组：1.胎前肩产后立即静脉注射（2分钟）组，2.胎盘产后立即静脉注射（2分钟）组，3.胎头产后立即滴注（20分钟）组。在每组中，对产后失血量、失血频率 > 500 ml 以及是否需要额外宫缩治疗进行了评估。结果。与甲基麦角新碱相比，使用催产素可显着减少产后失血量以及失血频率> 500 ml。与胎盘排出后静脉注射催产素（OR 0.33，95%CI 0.11-0.98）和胎儿前肩产后静脉注射甲基麦角新碱（OR 0.31，95%CI 0.11-0.85）相比，胎儿前肩产后静脉注射催产素可显着降低产后出血（PPH）的风险。结论。胎儿前肩分娩后立即静脉注射5 IU催产素是自然产程患者预防产后出血的首选治疗方法。
Objectives. To determine the efficacy of intravenous oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that after the third stage. Methods. A prospective study was undertaken: two major groups (oxytocin group and methylergometrine group) of 438 women with singleton pregnancy and vaginal delivery were studied during a 15-month period. These two groups were subdivided into three subgroups: 1. intravenous injection (two minutes) group immediately after the delivery of the fetal anterior shoulder, 2. intravenous injection (two minutes) group immediately after the delivery of the placenta, and 3. drip infusion (20 min) group immediately after the delivery of the fetal head. In each group, quantitative postpartum blood loss, frequencies of blood loss > 500 ml, and need of additional uterotonic treatment were evaluated. Results. As compared with methylergometrine, oxytocin administration was associated with a significant reduction in postpartum blood loss and in frequency of blood loss > 500 ml. The risk of PPH was significantly reduced with intravenous injection of oxytocin after delivery of the fetal anterior shoulder, compared with intravenous injection of oxytocin after expulsion of the placenta (OR 0.33, 95%CI 0.11-0.98) and intravenous injection of methylergometrine after delivery of the fetal anterior shoulder (OR 0.31, 95%CI 0.11-0.85). Conclusions. Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of PPH in patients with natural course of labor.