Benchimol M, Gondry J, Mention J E, Gagneur O, Boulanger J C
Centre de Gynécologie Obstétrique, 123, rue Camille-Desmoulins, 80054 Amiens.
J Gynecol Obstet Biol Reprod (Paris). 2001 Oct;30(6):576-83.
Delivery-induced hemorrhage is defined as a blood loss greater than 500 ml within the first 24 hours after delivery. Loss of more than 1000 ml is a sign of gravity. For certain authors, 40% of these hemorrhages could be avoided with systematic preventive measures using uterotonic agents to control the third phase of labor. The aim of our work was to assess the preventive efficacy of active management measures during the third phase of labor and to determine which agents are most effective.
We compared two protocols for controlled deliver: a conventional method using ocytocin (2.5 IU i.v. bolus), and a more recent method using a prostaglandin E1 analog: misoprostol (Cytotec, 3 tablets per os). We compared the two methods with a control group where no preventive measures were used, the standard procedure in our maternity unit.
Six hundred two women participated in the study. They were divided into 3 homogeneous groups (ocytocin group misoprostol group, control group). There was a 46% reduction in delivery-induced hemorrhage in the ocytocin group but only a minimal preventive effect against severe hemorrhage. Misoprostol did not demonstrate any efficacy in our study.
It would appear appropriate to take preventive measures against delivery-induced hemorrhage for all deliveries. A bolus intravenous injection of ocytocin immediately after delivery should bed used. The dose should be greater than that used in this study in order to prevent the development of severe hemorrhage. The most satisfactory results can be obtained with 5 IU (1 ampoule of Syntocinon). It is important to obtain a precise quantification of excessive blood loss in order to institute appropriate care rapidly. Misoprostol should be assessed with other prospective studies because of its easy administration, its low cost and easy storage, important advantages in countries with limited resources.
分娩期出血定义为分娩后24小时内失血超过500毫升。失血超过1000毫升是严重情况的标志。对于某些作者而言,通过使用宫缩剂系统预防措施来控制第三产程,40%的此类出血可避免。我们研究的目的是评估第三产程积极管理措施的预防效果,并确定哪种药物最有效。
我们比较了两种控制分娩的方案:一种是使用缩宫素(静脉推注2.5国际单位)的传统方法,另一种是使用前列腺素E1类似物米索前列醇(喜克溃,口服3片)的较新方法。我们将这两种方法与未采取预防措施的对照组进行比较,这是我们产科病房的标准程序。
602名女性参与了研究。她们被分为3个同质组(缩宫素组、米索前列醇组、对照组)。缩宫素组分娩期出血减少了46%,但对严重出血的预防效果甚微。米索前列醇在我们的研究中未显示出任何效果。
似乎对所有分娩采取预防分娩期出血的措施是合适的。分娩后应立即静脉推注缩宫素。剂量应大于本研究中使用的剂量,以预防严重出血的发生。使用5国际单位(1安瓿缩宫素)可获得最满意的结果。准确量化失血过多情况以便迅速采取适当护理措施很重要。由于米索前列醇给药方便、成本低且易于储存,在资源有限的国家具有重要优势,应通过其他前瞻性研究对其进行评估。