Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Brown University, Providence, RI 02905, USA.
Am J Obstet Gynecol. 2013 Mar;208(3):181-3. doi: 10.1016/j.ajog.2012.07.034. Epub 2012 Aug 1.
We reviewed the literature to determine the optimal medical treatment of postpartum hemorrhage caused by uterine atony. Of the available uterotonics, only misoprostol and oxytocin have undergone rigorous comparative study. Of the 2, misoprostol is inferior: 2 recent well-done randomized trials with enrollment of more than 2200 patients demonstrated that, in situations in which prophylactic oxytocin has already been utilized, additional oxytocin is as effective as or better than misoprostol in terminating bleeding, while avoiding the high rate of fever (22-58%) associated with misoprostol. The second of these trials demonstrated that misoprostol does not augment the effect of oxytocin. We conclude that in settings in which oxytocin is available, oxytocin should remain the mainstay of both prophylaxis and first-line treatment of postpartum hemorrhage caused by uterine atony. In the developed world, the use of misoprostol for postpartum hemorrhage should be infrequent.
我们查阅了文献，以确定治疗宫缩乏力性产后出血的最佳医学方法。在现有的宫缩剂中，只有米索前列醇和缩宫素经过了严格的对比研究。在这两者中，米索前列醇效果较差：最近的两项纳入 2200 多例患者的精心设计的随机试验表明，在已经预防性使用缩宫素的情况下，额外使用缩宫素在止血方面与米索前列醇一样有效或更有效，同时避免了米索前列醇相关的高热发生率（22-58%）。其中第二项试验表明，米索前列醇不会增强缩宫素的作用。我们的结论是，在有缩宫素的情况下，缩宫素应该仍然是预防和治疗宫缩乏力性产后出血的主要方法。在发达国家，米索前列醇用于产后出血的情况应该很少见。
