Uterotonic administration during cesarean section in Japan
Uterotonic administration during cesarean section in Japan
复制标题
日本剖宫产期间的宫缩管理
DOI：
10.1007/s00540-023-03194-4
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发表时间：
2023
影响因子：
2.8
通讯作者：
Nakajima Yoshiki
中科院分区：
文献类型：
--
作者：
Naruse Satoshi;Mazda Yusuke;Akinaga Chieko;Itoh Hiroaki;Nakajima Yoshiki
剖宫产术后给予子宫强张术是预防产后出血的常规做法，产后出血仍然是日本产妇死亡的主要原因。最近一项由产科麻醉专家发表的关于子宫紧张术的国际共识声明推荐静脉注射催产素（在线资源1,2）。然而，日本并没有关于子宫强张剂的种类、剂量和给药途径的具体指南。据报道，基于算法的子宫收缩管理方法导致的催产素剂量低于连续静脉注射方法[3]，这表明标准化的有用性。我们认为，异质实践期间CS是一个主要原因产后出血在日本。因此，我们进行了一项横断面研究，以了解日本CS期间子宫张力给药方式的多样性程度。本研究经滨松大学医学院研究伦理委员会批准（批准号22-190）。2019年8月，我们向日本母婴重症监护病房联络委员会成员的产科医生分发了一份在线问卷。该委员会由经卫生、劳动和福利部认证为需要高级围产期护理的产妇和新生儿设施的围产期中心的产科主任组成。该调查询问了参与者在他们的机构进行CS期间诱导子宫收缩的护理标准。每个问题都是由研究人员使用德尔菲技术开发的。回复直接通过电子邮件收集，2019年10月之前收到的回复被视为有效。我们最终获得了52家机构的回复，回复率为31.3%（52/166）。总的来说，96.2%（50/52）的机构在CS期间常规给予子宫张力，而3.8%（2/52）的机构没有。92.3%（48/52）的医院将催产素作为一线促子宫药物，7.7%（4/52）的医院选择甲麦角新碱作为一线促子宫药物。在使用催产素作为一线药物的机构中，75%的机构使用甲麦角新碱作为二线药物，8.3%的机构使用前列腺素F2α， 2.1%的机构使用前列腺素E1, 14.6%的机构没有提到特定的二线子宫张力。催产素以静脉注射为主；然而，子宫内膜注射（IMY）是常见的替代给药途径（66.7%和50.0%的医院分别采用静脉注射和IMY注射催产素）。在所有设施中，10.5%在CS期间常规使用甲麦角新碱（表1）。本研究观察了日本三级围产中心CS的实际子宫强张实践，揭示了不同设施的催产素管理不同。我们发现脑脊液中催产素给药的可变性与其他国家先前的报道一致[10]。在接受调查的机构中，有一半常规地在子宫内膜内注射催产素。在各种指南中，催产素被推荐用于静脉输注。肌内注射仅在无法静脉给药的情况下推荐使用，而IMY注射在指南中没有提及。通过IMY途径给予催产素需要比静脉注射途径更高的剂量才能获得对子宫相似的效果
Administering uterotonics after childbirth in cesarean section (CS) is a routine practice for preventing postpartum hemorrhage, which remains the primary cause of maternal death in Japan [1]. A recent international consensus statement on uterotonics in CS [2] published by obstetric anesthesia specialists recommended intravenous oxytocin (Online Resource 1, 2). However, Japan does not have specific guidelines on the type of uterotonic, the amount of agent to be administered, and administration route. It has been reported that the algorithm-based method of administering uterine contractions resulted in lower doses of oxytocin than the continuous intravenous method [3], suggesting the usefulness of standardization. We assumed that heterogeneous practices during CS are one of the leading causes of postpartum hemorrhage in Japan. Thus, we conducted a crosssectional study to understand the degree of diversity in the modality of uterotonic administration during CS in Japan. This study was approved by the Research Ethics Committee of Hamamatsu University School of Medicine (approval number, 22-190). In August 2019, we circulated an online questionnaire to obstetricians who were members of the Maternal Fetal Intensive Care Unit Liaison Council of Japan. The council consists of directors of the obstetrics departments of perinatal centers certified by the Ministry of Health, Labour and Welfare as facilities for parturients and neonates requiring advanced perinatal care. The survey asked participants about the standard of care in inducing uterine contractions during CS at their facilities. Each question was developed by researchers using the Delphi technique. Responses were collected directly via email and those received before October 2019 were considered valid. We ultimately obtained replies from 52 facilities, representing a response rate of 31.3%(52/166). In total, 96.2%(50/52) of facilities routinely administered uterotonics during CS, whereas 3.8%(2/52) of the facilities did not. Oxytocin was administered as a first-line uterotonic in 92.3%(48/52) of facilities, whereas 7.7%(4/52) of facilities chose methylergometrine as a first-line drug. Among facilities using oxytocin as the first-line drug, 75% administered methylergometrine as the second-line medication, 8.3% administered prostaglandin F2α, 2.1% administered prostaglandin E1, and 14.6% did not mention a specific secondline uterotonic. Oxytocin was mainly administered intravenously; however, intramyometrial (IMY) injection was a common alternative administration route (intravenous and IMY oxytocin were administered in 66.7% and 50.0% of facilities, respectively). Among all facilities, 10.5% routinely used methylergometrine during CS (Table 1). This study observed the actual practice of uterotonics in CS in tertiary perinatal centers in Japan, revealing that oxytocin is administered differently across facilities. Our finding of variability in oxytocin administration in CS is consistent with those of previous reports from other countries [4]. Of the facilities surveyed, half routinely administered oxytocin intramyometrially. Oxytocin is recommended for intravenous infusion in various guidelines. Intramuscular injection is recommended only in situations in which intravenous administration is not possible, whereas IMY injection is not mentioned in the guidelines [2]. Administering oxytocin via the IMY route requires a higher dose than the intravenous route to obtain a similar effect on uterine
澳大利亚和新西兰选择性剖腹产麻醉师使用宫缩剂的调查
影响因子：
1.5
作者：
N. Terblanche;P. Otáhal;J. Sharman
通讯作者：
J. Sharman
影响因子：
10.7
作者：
Heesen, M.;Carvalho, B.;Kinsella, S. M.
通讯作者：
Kinsella, S. M.
DOI：
10.1007/bf03012092
发表时间：
1998-07-01
期刊：
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
影响因子：
--
作者：
Dennehy, KC;Rosaeg, OP;Sylvain, JP
通讯作者：
Sylvain, JP