Dupont C, Ducloy-Bouthors A-S, Huissoud C
Réseau périnatal Aurore, université Lyon-1, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; EA 4129, laboratoire « santé, individu, société », faculté de médecine Laennec, 7, rue Guillaume-Paradin, 69372 Lyon cedex 08, France.
Pôle d'anesthésie-réanimation, maternité Jeanne de Flandre, CHRU de Lille, 59037 Lille cedex, France.
J Gynecol Obstet Biol Reprod (Paris). 2014 Dec;43(10):966-97. doi: 10.1016/j.jgyn.2014.09.025. Epub 2014 Nov 6.
To describe the clinical and pharmacological procedures for the prevention of Postpartum Haemorrhage (PPH).
We searched the Medline and the Cochrane Library (1st December 2004 to 1st March 2014) and we checked the international guidelines.
Vaginal birth: only the use of uterotonics reduces the incidence of PPH. Oxytocin is the treatment of choice if it is readily available (grade A). Oxytocin can be used either after the shoulders expulsion or rapidly after the placental delivery (grade B). A dose of 5 or 10IU must be administrated IV over at least 1minute or directly by an intramuscular injection (professional agreement) except in women with documented cardiovascular disease in which the duration of the IV perfusion should be over at least 5minutes (professional agreement). Mechanical procedures have no significant impact on PPH. The decision to use a collector bag is left to the medical team (professional agreement). A systematic complementary oxytocin perfusion is not recommended (professional agreement). Caesarean delivery: There is no evidence to recommend a particular type of caesarean technique to prevent PPH (professional agreement) but a lower uterine section is recommended (grade B). All types of incision expansion may be used (professional agreement). A controlled cord traction is associated with lower blood losses than manual removal of the placenta (grade B). A dose of 5 or 10IU can be injected (IV) over 1minute, and over 5minutes in women with cardiovascular disease (professional agreement). Carbetocin reduces the incidence of PPH but there is presently no inferiority study comparing oxytocin and carbetocin so that oxytocin remains the gold standard therapy to prevent PPH in C-section (professional agreement).
描述预防产后出血（PPH）的临床和药理学方法。
检索了Medline和Cochrane图书馆（2004年12月1日至2014年3月1日），并查阅了国际指南。
阴道分娩：仅使用宫缩剂可降低PPH的发生率。若催产素容易获得，则为首选治疗药物（A级）。催产素可在胎肩娩出后或胎盘娩出后迅速使用（B级）。必须静脉注射5或10IU，至少持续1分钟，或直接肌肉注射（专业共识），但有心血管疾病记录的女性除外，此类女性静脉滴注时间应至少超过5分钟（专业共识）。机械性操作对PPH无显著影响。是否使用收集袋由医疗团队决定（专业共识）。不建议进行系统性补充催产素静脉滴注（专业共识）。剖宫产：尚无证据推荐特定类型的剖宫产技术来预防PPH（专业共识），但推荐子宫下段剖宫产（B级）。可使用所有类型的切口扩展方式（专业共识）。与徒手剥离胎盘相比，控制脐带牵引导致的失血量更少（B级）。可在1分钟内静脉注射5或10IU，有心血管疾病的女性则在5分钟内注射（专业共识）。卡贝缩宫素可降低PPH的发生率，但目前尚无比较催产素和卡贝缩宫素的非劣效性研究，因此催产素仍是剖宫产预防PPH的金标准治疗药物（专业共识）。
