剖宫产术中胎盘的自然娩出或人工剥离：一项随机对照试验

Spontaneous delivery or manual removal of the placenta during caesarean section: a randomised controlled trial.

作者信息

Morales Michel, Ceysens Gilles, Jastrow Nicole, Viardot Caroline, Faron Gilles, Vial Yvan, Kirkpatrick Christine, Irion Olivier, Boulvain Michel

机构信息

Department of Obstetrics and Gynaecology, Geneva University Hospitals, Genèva 14, Switzerland.

出版信息

BJOG. 2004 Sep;111(9):908-12. doi: 10.1111/j.1471-0528.2004.00228.x.

DOI:10.1111/j.1471-0528.2004.00228.x

PMID:15327603

Abstract

OBJECTIVE

To compare blood loss with spontaneous delivery and manual removal of the placenta during caesarean section.

DESIGN

A randomised controlled trial.

SETTING

Four university hospitals between September 1999 and June 2002.

POPULATION

A total of 472 women delivering by caesarean section at term were randomised to spontaneous placental delivery (n= 235) or manual removal (n= 237).

METHODS

The allocation was made by opening the next available of a series of sealed opaque envelopes and derived from a computer-generated list of numbers.

MAIN OUTCOME MEASURES

Significant blood loss, defined as either a drop in haemoglobin of greater than 2.5 g/dL, or the need for blood transfusion.

RESULTS

The mean interval between delivery of the newborn and the placenta was longer in the spontaneous delivery group (3.4 vs 1.9 minutes), but the mean duration of the operation was similar. Significant blood loss occurred in 30 women (13%) in the spontaneous delivery group and 49 women (21%) in the manual removal one (RR 0.62; 95% CI 0.41-0.94). Post-operative fever affected 6 and 5 cases, respectively, and antibiotics were used in 14 and 12 cases, respectively.

CONCLUSIONS

Allowing spontaneous delivery of the placenta reduces significant blood loss without increasing operating time.

摘要

目的

比较剖宫产术中胎盘自然娩出与人工剥离胎盘的失血量。

设计

一项随机对照试验。

地点

1999年9月至2002年6月期间的四家大学医院。

研究对象

总共472名足月剖宫产分娩的妇女被随机分为胎盘自然娩出组（n = 235）或人工剥离组（n = 237）。

方法

通过打开一系列密封不透明信封中的下一个信封进行分组，分组依据是计算机生成的数字列表。

主要观察指标

严重失血，定义为血红蛋白下降超过2.5 g/dL或需要输血。

结果

自然娩出组新生儿与胎盘娩出的平均间隔时间更长（3.4分钟对1.9分钟），但手术平均时长相似。自然娩出组有30名妇女（13%）发生严重失血，人工剥离组有49名妇女（21%）发生严重失血（相对危险度0.62；95%可信区间0.41 - 0.94）。术后发热分别影响6例和5例，分别有14例和12例使用了抗生素。