McCormick M L, Sanghvi H C G, Kinzie B, McIntosh N
JHPIEGO Corporation, Baltimore, MD, USA.
Int J Gynaecol Obstet. 2002 Jun;77(3):267-75. doi: 10.1016/s0020-7292(02)00020-6.
To review the literature to determine the most effective methods for preventing postpartum hemorrhage (PPH), the single most important cause of maternal death worldwide.
Systematic review of published randomized controlled trials and relevant reviews.
Review of the literature confirms that active management of the third stage of labor, especially the administration of uterotonic drugs, reduces the risk of PPH due to uterine atony without increasing the incidence of retained placenta or other serious complications. Oxytocin is the preferred uterotonic drug compared with syntometrine, but misoprostol also can be used to prevent hemorrhage in situations where parenteral medications are not available (e.g. at home births in developing countries).
The use of active management of the third stage of labor to prevent PPH due to uterine atony should be expanded, especially in developing country settings.
回顾文献以确定预防产后出血（PPH）的最有效方法，产后出血是全球孕产妇死亡的单一最重要原因。
对已发表的随机对照试验和相关综述进行系统评价。
文献综述证实，积极处理第三产程，尤其是使用宫缩剂，可降低因子宫收缩乏力导致的产后出血风险，且不会增加胎盘残留或其他严重并发症的发生率。与卡贝缩宫素相比，缩宫素是首选的宫缩剂，但在无法获得注射用药物的情况下（如发展中国家的家庭分娩），米索前列醇也可用于预防出血。
应扩大积极处理第三产程以预防因子宫收缩乏力导致的产后出血的应用范围，尤其是在发展中国家。
