前列腺素 E2 类似物舒普生治疗宫缩乏力性产后出血。

Prostaglandin E2 analogue sulprostone for treatment of atonic postpartum hemorrhage.

机构信息

From the Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, the Université Paris Diderot, Inserm U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, and the Université Pierre et Marie Curie, Paris, France; and the Aurore Perinatal Network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.

出版信息

Obstet Gynecol. 2011 Aug;118(2 Pt 1):257-265. doi: 10.1097/AOG.0b013e3182255335.

DOI:10.1097/AOG.0b013e3182255335

PMID:21775840

Abstract

OBJECTIVES

Use of prostaglandins, including sulprostone (an E2 analog), is recommended for second-line uterotonic treatment of atonic postpartum hemorrhage and might be considered as an indicator of quality of care in severe atonic postpartum hemorrhage management. Our objective was to estimate whether sulprostone was appropriately used and how it was tolerated in women with atonic postpartum hemorrhage.

METHODS

This large population-based study (146,781 deliveries) included 4,038 women with clinically assessed atonic postpartum hemorrhage in 106 French hospitals during 1 year. Severe postpartum hemorrhage was defined as one of the following: hemoglobin decline of 4 g/dL or more, transfusion, arterial embolization, surgical procedures, transfer to intensive care unit, or death. Sulprostone use in severe atonic postpartum hemorrhage was analyzed according to the mode of delivery and the characteristics of the maternity units.

RESULTS

Rates of sulprostone use were only 33.9% (n = 1,370) and 53.5% (n = 657) among women with atonic (n = 4 ,038) and severe atonic (n = 1,227) postpartum hemorrhage, respectively. In the latter population, sulprostone administration was less frequent after vaginal delivery than after cesarean delivery (45.6% compared with 86.5%, P<.01) in units performing fewer than 1,500 annual deliveries in public nonuniversity hospitals and in units where the obstetrician or anesthesiologist was not present 24 hours per day, 7 days per week. Fifty-one of the 1,370 women with sulprostone-treated atonic postpartum hemorrhage (3.7%, 95% confidence interval [CI] 2.7-4.7) experienced side effects, including seven (0.5%, 95% CI 0.2-1.0) with severe cardiovascular or respiratory symptoms that resolved when the hypovolemic shock was corrected and drug administration was stopped.

CONCLUSION

Sulprostone is underused for treating severe atonic postpartum hemorrhage after vaginal delivery, despite low rates of severe side effects in this population-based study.

LEVEL OF EVIDENCE

: III.

摘要

目的

前列腺素（包括舒普生，E2 类似物）的使用被推荐用于宫缩乏力性产后出血的二线治疗，并且可能被视为严重宫缩乏力性产后出血管理中护理质量的一个指标。我们的目的是评估舒普生在宫缩乏力性产后出血患者中的使用是否恰当，以及其在这些患者中的耐受情况。

方法

这项基于人群的大型研究（146781 例分娩）纳入了 106 家法国医院在 1 年内收治的 4038 例临床诊断为宫缩乏力性产后出血的妇女。严重产后出血定义为以下之一：血红蛋白下降 4 g/dL 或以上、输血、动脉栓塞、手术、转入重症监护病房或死亡。根据分娩方式和产科单位的特点，分析舒普生在严重宫缩乏力性产后出血中的使用情况。

结果

宫缩乏力性产后出血患者（n=4038）和严重宫缩乏力性产后出血患者（n=1227）中使用舒普生的比例分别为 33.9%（n=1370）和 53.5%（n=657）。在后一组人群中，与剖宫产相比，在公共非大学附属医院和产科医生或麻醉师每周 7 天、每天 24 小时均不在岗、每年分娩量少于 1500 例的单位，舒普生用于治疗产后出血的频率较低（45.6%比 86.5%，P<.01）。在 1370 例接受舒普生治疗的宫缩乏力性产后出血患者中，有 51 例（3.7%，95%置信区间[CI]为 2.7%~~4.7%）出现了副作用，包括 7 例（0.5%，95%CI 为 0.2%~~1.0%）出现严重心血管或呼吸系统症状，这些症状在纠正低血容量性休克和停止药物治疗后得到缓解。