Chantrapitak Wanchai, Srijuntuek Kamol, Wattanaluangarun Renu
Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2011 Jun;94(6):649-56.
To determine the efficacy and amount of blood loss of the maneuver utilizing lower uterine segment compression (LUSC) for the prevention of early postpartum hemorrhage.
The present study enrolled 686 mothers with singleton pregnancy, gestational ages between 28 and 42 weeks, at the Department of Obstetrics and Gynecology, Charoenkrung Pracharak Hospital, Bangkok between July 2009 and March 2010. All subjects had no past medical history and delivered by vaginal route. They were divided into two groups, the experimental group and the control group. Mothers in both experimental and control groups were treated with the same methods, oxytocin administration before and after delivery, clamping and cutting umbilical cords within three minutes after birth of the newborns, and placental delivery done by controlled cord traction together with uterine massage at the fundus through the abdominal wall immediately. In addition, in the experimental group, the subjects were assisted by LUSC for 10 minutes. The amount of blood loss was measured and recorded two hours after delivery of the placentas in both experimental and control groups.
Among 686 cases, nine cases were excluded from the present study. They were composed of five cases in the control group, with retained placenta, and four cases in the experimental group because of retained placenta, retained placental fragments, severe perineum tear, and vaginal hematoma. Subjects in the experimental group who were additionally assisted by LUSC were found to have lesser incidence of PPH with statistical significance in comparison to those in the control group (2.9% vs. 6.8%; relative risk 0.43, 95% confidence interval 0.21-0.90, p = 0.02). The amount of blood loss reduced by 29.26 ml (289.70 +/- 179.53 mlvs. 260.44 +/- 116.30 ml), p = 0.012).
Lower uterine segment compression (LUSC) significantly reduced the rate of PPH and amount of blood loss after vaginal delivery The efficacy of this technique was over the conventional method in labor room care. Besides, LUSC was easy and safe. Neither anesthesia nor extra-expense was needed. LUSC was considered the innovation for management of postpartum hemorrhage. The maneuver was able to reduce the risk of maternal morbidity and mortality after the delivery of newborns.
确定利用子宫下段压迫法（LUSC）预防产后早期出血的疗效及失血量。
本研究纳入了2009年7月至2010年3月期间在曼谷Charoenkrung Pracharak医院妇产科就诊的686名单胎妊娠、孕周在28至42周之间的母亲。所有受试者均无既往病史且经阴道分娩。她们被分为两组，即实验组和对照组。实验组和对照组的母亲均采用相同的方法进行治疗，包括分娩前后使用缩宫素、新生儿出生后三分钟内钳夹并剪断脐带，以及立即通过腹壁在宫底进行子宫按摩并采用控制脐带牵引的方法娩出胎盘。此外，在实验组中，受试者接受10分钟的子宫下段压迫法辅助。在两组娩出胎盘后两小时测量并记录失血量。
在686例病例中，9例被排除在本研究之外。其中对照组有5例因胎盘残留，实验组有4例因胎盘残留、胎盘碎片残留、严重会阴撕裂和阴道血肿被排除。发现接受子宫下段压迫法辅助的实验组受试者产后出血发生率低于对照组，具有统计学意义（2.9%对6.8%；相对危险度0.43，95%置信区间0.21 - 0.90，p = 0.02）。失血量减少了29.26毫升（289.70±179.53毫升对260.44±116.30毫升），p = 0.012）。
子宫下段压迫法（LUSC）显著降低了阴道分娩后产后出血的发生率及失血量。该技术在产房护理中的疗效优于传统方法。此外，子宫下段压迫法简便且安全。既不需要麻醉也无需额外费用。子宫下段压迫法被认为是产后出血管理的创新方法。该操作能够降低新生儿娩出后母亲发病和死亡的风险。
