Villar J, Gülmezoglu A M, Hofmeyr G Justus, Forna F
United Nations Development Programme/United Nations Population Fund/World Health Organization/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
Obstet Gynecol. 2002 Dec;100(6):1301-12. doi: 10.1016/s0029-7844(02)02371-2.
To assess the effects of prophylactic misoprostol use in the third stage of labor compared with injectable uterotonics or placebo or no treatment.
The Cochrane Pregnancy and Childbirth Group trials register; the Cochrane Library, including databases such as the database of systematic reviews and the Cochrane Controlled Trials Register; and MEDLINE were searched. Researchers in the field were also contacted. The date of the latest search was March 1, 2002.
Randomized trials comparing misoprostol with injectable oxytocin or oxytocin-ergot preparations to prevent postpartum hemorrhage or placebo/no treatment as active management of the third stage of labor were eligible for inclusion. Eligibility and trial quality were assessed following selected criteria. Data were extracted and analyzed using RevMan software.
TABULATION, INTEGRATION, AND RESULTS: Sixteen randomized trials with a total of 28,138 women were considered. Data were available for 27,498 women. Oral misoprostol (600 microg) is less effective than injectable uterotonics in reducing blood loss at least 1000 mL (relative risk [RR] 1.36, 95% confidence interval [CI] 1.17, 1.58) and increases the use of additional uterotonics. Shivering and pyrexia (temperature greater than 38C) are the main side effects of misoprostol and are dose related. Compared with injectable uterotonics, the RR of "any shivering" with misoprostol (600 microg) is 3.27 (95% CI 3.01, 3.56) and pyrexia is 6.96 (95% CI 5.65, 8.57). The RR of blood loss of 500 mL or more is 1.11 (95% CI 0.87, 1.43) and the RR of use of additional uterotonics is 1.80 (1.13, 2.85) in the three trials (1441 women) comparing rectal misoprostol (400 microg) with injectable uterotonics.
Injectable oxytocin or oxytocin-ergot preparations are more effective than misoprostol as part of the active management of the third stage of labor.
评估在第三产程预防性使用米索前列醇与注射用宫缩剂、安慰剂或不治疗相比的效果。
检索了Cochrane妊娠与分娩组试验注册库；Cochrane图书馆，包括系统评价数据库和Cochrane对照试验注册库等数据库；以及MEDLINE。还联系了该领域的研究人员。最新检索日期为2002年3月1日。
比较米索前列醇与注射用缩宫素或缩宫素 - 麦角制剂以预防产后出血，或与安慰剂/不治疗作为第三产程积极处理措施的随机试验符合纳入标准。根据选定标准评估纳入资格和试验质量。使用RevMan软件提取和分析数据。
列表、整合与结果：共纳入16项随机试验，涉及28138名女性。有27498名女性的数据可用。口服米索前列醇（600微克）在减少至少1000毫升失血方面不如注射用宫缩剂有效（相对危险度[RR] 1.36，95%置信区间[CI] 1.17，1.58），并增加了额外宫缩剂的使用。寒战和发热（体温高于38℃）是米索前列醇的主要副作用，且与剂量相关。与注射用宫缩剂相比，米索前列醇（600微克）出现“任何寒战”的RR为3.27（95% CI 3.01，3.56），发热的RR为6.96（95% CI 5.65，8.57）。在三项比较直肠用米索前列醇（400微克）与注射用宫缩剂的试验（1441名女性）中，失血500毫升或更多的RR为1.11（95% CI 0.87，1.43），额外使用宫缩剂的RR为1.80（1.13，2.85）。
作为第三产程积极处理措施的一部分，注射用缩宫素或缩宫素 - 麦角制剂比米索前列醇更有效。
