Hofmeyr G Justus, Abdel-Aleem Hany, Abdel-Aleem Mahmoud A
Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, East London, South Africa.
Cochrane Database Syst Rev. 2008 Jul 16(3):CD006431. doi: 10.1002/14651858.CD006431.pub2.
Postpartum haemorrhage (PPH) (bleeding from the genital tract after childbirth) is a major cause of maternal mortality and disability, particularly in under-resourced areas. In these settings, poor nutrition, malaria and anaemia may aggravate the effects of PPH. In addition to the standard known strategies to prevent and treat PPH, there is a need for simple, non-expensive techniques which can be applied in low-resourced settings to prevent or treat PPH.
To determine the effectiveness of uterine massage after birth and before or after delivery of the placenta, or both, to reduce postpartum blood loss and associated morbidity and mortality.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2) and PubMed (1966 to June 2007).
All published, unpublished and ongoing randomised controlled trials comparing uterine massage alone or in addition to uterotonics before or after delivery of the placenta, or both, to non-massage.
Both authors extracted the data independently using the agreed form.
One randomised controlled trial in which 200 women were randomised to receive uterine massage or no massage after active management of the third stage of labour. The numbers of women with blood loss more than 500 ml was small, with wide confidence intervals and no statistically significant difference (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.16 to 1.67). There were no cases of retained placenta in either group. The mean blood loss was less in the uterine massage group at 30 minutes (mean difference (MD) -41.60, 95% CI -75.16 to -8.04) and 60 minutes after enrolment (MD -77.40, 95% CI -118.71 to -36.09 ml) . The need for additional uterotonics was reduced in the uterine massage group (RR 0.20, 95% CI 0.08 to 0.50). Two blood transfusions were administered in the control group.
AUTHORS' CONCLUSIONS: The present review adds support to the 2004 joint statement of the International Confederation of Midwives and the International Federation of Gynaecologists and Obstetricians on the management of the third stage of labour, that uterine massage after delivery of the placenta is advised to prevent PPH. However, due to the limitations of the one trial reviewed, trials with sufficient numbers to estimate the effects of sustained uterine massage with great precision, both with and in the absence of uterotonics, are needed.
产后出血（分娩后生殖道出血）是孕产妇死亡和残疾的主要原因，在资源匮乏地区尤为如此。在这些地区，营养不良、疟疾和贫血可能会加重产后出血的影响。除了预防和治疗产后出血的标准已知策略外，还需要简单、低成本的技术，可应用于资源匮乏地区以预防或治疗产后出血。
确定在胎儿娩出后、胎盘娩出前或后或两者均进行子宫按摩，以减少产后失血及相关发病率和死亡率的有效性。
我们检索了Cochrane妊娠与分娩组试验注册库（2008年3月）、Cochrane对照试验中心注册库（《Cochrane图书馆》2007年第2期）和PubMed（1966年至2007年6月）。
所有已发表、未发表及正在进行的随机对照试验，比较单独进行子宫按摩或在胎盘娩出前或后或两者均联合使用宫缩剂与不进行按摩的效果。
两位作者使用商定的表格独立提取数据。
一项随机对照试验，200名妇女在第三产程积极处理后被随机分组，分别接受子宫按摩或不接受按摩。失血超过500ml的妇女数量较少，置信区间较宽，无统计学显著差异（风险比（RR）0.52，95%置信区间（CI）0.16至1.67）。两组均无胎盘残留病例。子宫按摩组在入组后30分钟（平均差（MD）-41.60，95%CI -75.16至-8.04）和60分钟时的平均失血量较少（MD -77.40，95%CI -118.71至-36.09ml）。子宫按摩组对额外宫缩剂的需求减少（RR 0.20，95%CI 0.08至0.50）。对照组有2例接受了输血。
本综述支持国际助产士联合会和国际妇产科联合会2004年关于第三产程管理的联合声明，即建议在胎盘娩出后进行子宫按摩以预防产后出血。然而，由于所审查的一项试验存在局限性，需要进行有足够样本量的试验，以精确估计在使用和不使用宫缩剂情况下持续子宫按摩的效果。
