Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA.
Int J Obstet Anesth. 2013 Jul;22(3):194-9. doi: 10.1016/j.ijoa.2013.03.007. Epub 2013 May 18.
Due to safety concerns when oxytocin is administered in an uncontrolled fashion, and recent dose-response data that indicate oxytocin's effectiveness at doses lower than those traditionally used, we instituted a new protocol for the infusion of oxytocin during the third stage of labor and in the immediate postpartum period. We undertook this study to confirm that this change in practice did not have untoward effects on postpartum hemorrhage rates.
In this retrospective review, patients who delivered in the six months before (PRE group) and patients who delivered in the six months after (POST group) the new protocol had been introduced were identified through an institutional database and their medical records were reviewed. The primary outcome variable was the postpartum hemorrhage rate. Secondary outcomes included maternal and fetal co-morbidities, protocol compliance, administration of other uterotonic agents, use of Bakri balloons and B-Lynch sutures, rate of uterine artery embolization and peripartum hysterectomy, need for red blood cell transfusion, and drop in hemoglobin after delivery. Categorical data were analyzed using Chi-squared or Fisher's Exact test, as appropriate. Continuous data were analyzed using a Mann-Whitney U test. A P value <0.05 was required to reject the null hypothesis.
A total of 1572 medical records were reviewed. Postpartum hemorrhage occurred in 9.0% of PRE patients and 7.1% of POST patients, and was not different between groups (P=0.17). Carboprost use was lower in the POST group, but no other differences were noted.
Adoption of a protocol to infuse oxytocin in a controlled manner at a lower dose than that historically used was not associated with an increased incidence of postpartum hemorrhage.
由于催产素在不受控制的情况下使用存在安全隐患，以及最近的剂量反应数据表明催产素在低于传统使用剂量时仍具有有效性，我们制定了新的第三产程和产后即刻催产素输注方案。我们开展此项研究是为了证实这种方案的改变不会对产后出血率产生不良影响。
本回顾性研究通过机构数据库确定了在新方案引入前 6 个月（PRE 组）和引入后 6 个月（POST 组）分娩的患者，并对其病历进行了回顾。主要结局变量是产后出血率。次要结局包括母婴合并症、方案依从性、其他缩宫剂的使用、Bakri 球囊和 B-Lynch 缝合术的使用、子宫动脉栓塞和围产期子宫切除术的发生率、红细胞输注的需求以及产后血红蛋白下降。分类数据采用卡方检验或 Fisher 确切概率法进行分析，连续数据采用 Mann-Whitney U 检验进行分析。P 值＜0.05 时拒绝零假设。
共回顾了 1572 份病历。PRE 组产后出血发生率为 9.0%，POST 组为 7.1%，两组间无差异（P=0.17）。POST 组卡前列素的使用减少，但未观察到其他差异。
采用一种方案以较低剂量（低于既往使用剂量）控制输注催产素并不会增加产后出血的发生率。
