Ugwu I A, Enabor O O, Adeyemi A B, Lawal O O, Oladokun A, Olayemi O
Department of Obstetrics and Gynaecology, University College Hospital , Ibadan , Nigeria.
J Obstet Gynaecol. 2014 Jul;34(5):407-11. doi: 10.3109/01443615.2014.899329. Epub 2014 Apr 11.
The aim of the study was to compare the efficacy of sublingual misoprostol in addition to intravenous oxytocin, with oxytocin alone, in reducing blood loss during and following caesarean section. A total of 120 women undergoing caesarean delivery at the University College Hospital, Ibadan, were randomised into two equal groups. In Group A, 20 IU of intravenous oxytocin was given after umbilical cord clamping, while in Group B, the women received 400 μg misoprostol sublingually and 20 IU oxytocin intravenously. The outcome measures were blood loss, additional uterotonics, change in packed cell volume and side-effect profile. Associations between variables were determined by the χ(2) and Student's t-test. Relative risks were calculated for side-effects; the level of significance was p < 0.05. Intraoperative and postoperative blood loss were significantly lower in Group B (451.3 ml vs 551.2 ml, p = 0.007; 22.7 vs 42.2 ml, p < 0.001, respectively). In Group B, women were 7.4 (p < 0.001) and 9.0 (p = 0.008) times more likely to experience shivering and fever, respectively. The need for additional uterotonics was greater in the oxytocin group (66.7% vs 27.6%, p < 0.001). The addition of sublingual misoprostol to intravenous oxytocin reduces postpartum blood loss and the need for additional uterotonics. There is however, an increased risk of shivering and fever with this combination.
本研究的目的是比较在剖宫产术中及术后，舌下含服米索前列醇联合静脉滴注缩宫素与单纯静脉滴注缩宫素在减少失血方面的疗效。共有120名在伊巴丹大学学院医院接受剖宫产的妇女被随机分为两组。A组在脐带结扎后静脉滴注20 IU缩宫素，而B组妇女舌下含服400 μg米索前列醇并静脉滴注20 IU缩宫素。观察指标包括失血量、额外使用的宫缩剂、红细胞压积变化和副作用情况。变量之间的关联通过χ(2)检验和学生t检验确定。计算副作用的相对风险；显著性水平为p < 0.05。B组术中及术后失血量显著更低（分别为451.3 ml对551.2 ml，p = 0.007；22.7对42.2 ml，p < 0.001）。在B组中，妇女出现寒战和发热的可能性分别高出7.4倍（p < 0.001）和9.0倍（p = 0.008）。缩宫素组额外使用宫缩剂的需求更大（66.7%对27.6%，p < 0.001）。静脉滴注缩宫素时加用舌下含服米索前列醇可减少产后失血量及额外使用宫缩剂的需求。然而，这种联合用药会增加寒战和发热的风险。
