Whitehouse Katherine, Tschann Mary, Davis James, Soon Reni, Salcedo Jennifer, Friedlander EmmaKate, Kaneshiro Bliss
University of Hawaii, John A. Burns School of Medicine, Department of Obstetrics, Gynecology & Women's Health, 1319 Punahou Street, Ste 824, Honolulu, HI 96826.
University of Hawaii, John A. Burns School of Medicine, Department of Biostatistics & Data Management, 651 Ilalo Street, Biosciences Building, Ste 211, Honolulu, HI 96813.
Contraception. 2017 Jul;96(1):19-24. doi: 10.1016/j.contraception.2017.04.003. Epub 2017 May 5.
Some providers use oxytocin during dilation and evacuation (D&E) to prevent or treat hemorrhage, although evidence to support this is scarce. We sought to describe the association between prophylactic oxytocin use, estimated blood loss (EBL), and surgical outcomes during D&E.
We performed a chart review of 730 women at 14 to 26 weeks' gestation who had a D&E at our institution between May 2010 and May 2014 to assess the association between prophylactic oxytocin use and EBL. We determined whether sociodemographic and health-related factors were associated with excessive blood loss (EBL≥250 mL) and whether oxytocin use was associated with complications, including hemorrhage (i.e., EBL≥500 mL or interventions for bleeding). We performed univariate analyses and multivariable regression models to evaluate the relationship between health-related factors and EBL≥250 mL.
Providers used prophylactic oxytocin in 59.9% of procedures. Asian (p=.005 and Native Hawaiian/Pacific Islander (p=.005) race, nulliparity (p=.007) and higher gestational age (p<.001) were associated with prophylactic oxytocin use. We found no difference in mean EBL (116.2±105.5 mL versus 130.7±125.5 mL, p=.09), EBL≥250 mL (31.4% vs. 68.6%, p=.15) or complications (6.1% vs. 7.1%, p=.73) including hemorrhage (1.4% vs. 5.3%, p=.14) between those who did not receive prophylactic oxytocin and those who did. No transfusions occurred in either group. In multivariable regression modeling, the adjusted OR for excessive blood loss was 0.42 (95% confidence interval 0.16-1.07) with prophylactic oxytocin use.
Prophylactic oxytocin use during D&E was not associated with hemorrhage or transfusion in our population.
Routine use of interventions for bleeding, such as intravenous oxytocin, should be based on scientific evidence or not performed. Findings from our study provide information on how oxytocin use is associated with blood loss during D&E.
一些医疗服务提供者在扩张刮宫术（D&E）期间使用缩宫素以预防或治疗出血，尽管支持这一做法的证据很少。我们试图描述预防性使用缩宫素、估计失血量（EBL）与D&E手术结果之间的关联。
我们对2010年5月至2014年5月在我院接受D&E的730名妊娠14至26周的女性进行了病历回顾，以评估预防性使用缩宫素与EBL之间的关联。我们确定社会人口统计学和健康相关因素是否与失血过多（EBL≥250 mL）相关，以及缩宫素的使用是否与包括出血（即EBL≥500 mL或因出血进行干预）在内的并发症相关。我们进行了单因素分析和多变量回归模型，以评估健康相关因素与EBL≥250 mL之间的关系。
在59.9%的手术中，医疗服务提供者使用了预防性缩宫素。亚洲人（p = 0.005）和夏威夷原住民/太平洋岛民（p = 0.005）种族、未生育（p = 0.007）以及较高的孕周（p < 0.001）与预防性使用缩宫素相关。我们发现，未接受预防性缩宫素的患者与接受预防性缩宫素的患者在平均EBL（116.2±105.5 mL对130.7±125.5 mL，p = 0.09）、EBL≥250 mL（31.4%对68.6%，p = 0.15）或并发症（6.1%对7.1%，p = 0.73）包括出血（1.4%对5.3%，p = 0.14）方面没有差异。两组均未发生输血情况。在多变量回归模型中，预防性使用缩宫素时，失血过多的调整后比值比为0.42（95%置信区间0.16 - 1.07）。
在我们的研究人群中，D&E期间预防性使用缩宫素与出血或输血无关。
对于出血干预措施，如静脉注射缩宫素的常规使用，应基于科学证据，否则不应实施。我们的研究结果提供了关于缩宫素使用与D&E期间失血之间关联的信息。
