Jardine Jennifer E, Law Penny, Hogg Matthew, Murphy Deirdre, Khan Khalid S
aRoyal London Hospital, Barts Health NHS Trust bWomen's Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London cHillingdon Hospital, London, UK dDepartment of Obstetrics and Gynaecology, Trinity College, University of Dublin, Ireland eUniversity College London, London, UK.
Curr Opin Obstet Gynecol. 2016 Dec;28(6):492-498. doi: 10.1097/GCO.0000000000000328.
Caesarean section rates are increasing across the world. Postpartum haemorrhage is a major cause of morbidity and mortality; major haemorrhage is more common after caesarean delivery. There is a wide range of practice in the prevention and treatment of postpartum haemorrhage at caesarean section. The aim of this review is to summarize current opinion in the management of postpartum haemorrhage at caesarean section.
Recent large randomized controlled trials have shown a possible effect from the routine use of tranexamic acid and ergometrine. Small randomized controlled trials have shown a possible benefit from using carbetocin.
The impact of postpartum haemorrhage can be reduced by antenatal correction of anaemia. Intraoperative medical management consists of oxytocinon, additional oxytocics +/- tranexamic acid, with at present limited evidence as to the order in which these should be considered. Trials of routine use of cell salvage and tranexamic acid are currently underway.
剖宫产率在全球范围内呈上升趋势。产后出血是发病和死亡的主要原因；大出血在剖宫产术后更为常见。剖宫产术后产后出血的预防和治疗存在广泛的实践差异。本综述的目的是总结剖宫产术后产后出血管理的当前观点。
近期大型随机对照试验表明，常规使用氨甲环酸和麦角新碱可能有效果。小型随机对照试验表明，使用卡贝缩宫素可能有益。
产前纠正贫血可降低产后出血的影响。术中药物管理包括缩宫素、额外的宫缩剂±氨甲环酸，目前关于这些药物使用顺序的证据有限。目前正在进行常规使用血液回收和氨甲环酸的试验。
