Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam Q M
Prince of Songkla University, Department of Obstetrics and Gynecology, Faculty of Medicine, Hat Yai, Songkhla, Thailand, 90110.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD005456. doi: 10.1002/14651858.CD005456.pub2.
Previous research has shown that the prophylactic use of uterotonic agents in the third stage of labour reduces postpartum blood loss and moderate to severe postpartum haemorrhage. This is one of a series of systematic reviews assessing the effects of prophylactic use of uterotonic drugs - here, prophylactic ergot alkaloids compared with no uterotonic agents, and different regimens of administration of ergot alkaloids.
To determine the effectiveness and safety of prophylactic use of ergot alkaloids in the third stage of labour compared with no uterotonic agents, as well as with different routes or timing of administration for prevention of postpartum haemorrhage.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4) and MEDLINE (1966 to December 2006).
All randomised or quasi-randomised controlled trials comparing prophylactic ergot alkaloids with no uterotonic agents or comparing different routes or timings of administration of ergot alkaloids in the third stage of labour among women giving birth vaginally.
We systematically reviewed the potential studies, considered eligible studies, assessed the validity of each included study and extracted data independently.
We included six studies comparing ergot alkaloids with no uterotonic agents, with a total of 1996 women in ergot alkaloids group and 1945 women in placebo or no treatment group. The use of injected ergot alkaloids in the third stage of labour significantly decreased mean blood loss (weighted mean difference -83.03 ml, 95% confidence interval (CI) -99.39 to -66.66 ml) and postpartum haemorrhage of at least 500 ml (relative risk (RR) 0.38, 95% CI 0.21 to 0.69). The risk of retained placenta or manual removal of the placenta, or both, were inconsistent. Ergot alkaloids increased the risk of vomiting (RR 11.81, 95% CI 1.78 to 78.28), elevation of blood pressure (RR 2.60, 95% CI 1.03 to 6.57) and pain after birth requiring analgesia (RR 2.53, 95% CI 1.34 to 4.78). One study compared oral ergometrine with placebo and showed no significant benefit of ergometrine over placebo. No maternal adverse effects were reported. There were no included trials that compared different administration regimens of ergot alkaloids.
AUTHORS' CONCLUSIONS: Prophylactic intramuscular or intravenous injections of ergot alkaloids are effective in reducing blood loss and postpartum haemorrhage, but adverse effects include vomiting, elevation of blood pressure and pain after birth requiring analgesia, particularly with the intravenous route of administration.
先前的研究表明，在分娩第三阶段预防性使用宫缩剂可减少产后出血以及中度至重度产后大出血。这是一系列评估预防性使用宫缩剂效果的系统评价之一——此处是将预防性使用麦角生物碱与不使用宫缩剂，以及麦角生物碱的不同给药方案进行比较。
确定与不使用宫缩剂相比，在分娩第三阶段预防性使用麦角生物碱的有效性和安全性，以及不同给药途径或给药时间对预防产后出血的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2006年12月30日）、Cochrane对照试验中央注册库（CENTRAL）（《Cochrane图书馆》2006年第4期）以及MEDLINE（1966年至2006年12月）。
所有比较预防性使用麦角生物碱与不使用宫缩剂，或比较阴道分娩妇女在分娩第三阶段麦角生物碱不同给药途径或给药时间的随机或半随机对照试验。
我们系统地回顾了潜在研究，考虑符合条件的研究，评估每项纳入研究的有效性并独立提取数据。
我们纳入了6项比较麦角生物碱与不使用宫缩剂的研究，麦角生物碱组共有1996名妇女，安慰剂或未治疗组有1945名妇女。在分娩第三阶段使用注射用麦角生物碱可显著减少平均失血量（加权平均差-83.03 ml，95%置信区间（CI）-99.39至-66.66 ml）以及至少500 ml的产后大出血（相对危险度（RR）0.38，95%CI 0.21至0.69）。胎盘滞留或人工剥离胎盘，或两者兼有的风险并不一致。麦角生物碱增加了呕吐风险（RR 11.81，95%CI 1.78至78.28）、血压升高风险（RR 2.60，95%CI 1.03至6.57）以及产后需要镇痛的疼痛风险（RR 2.53，95%CI 1.34至4.78）。一项比较口服麦角新碱与安慰剂的研究表明，麦角新碱并不比安慰剂有显著优势。未报告产妇有不良反应。没有纳入比较麦角生物碱不同给药方案的试验。
预防性肌内注射或静脉注射麦角生物碱可有效减少失血量和产后出血，但不良反应包括呕吐、血压升高以及产后需要镇痛的疼痛，尤其是静脉给药途径。
