Saccone Gabriele, Della Corte Luigi, D'Alessandro Pietro, Ardino Bruno, Carbone Luigi, Raffone Antonio, Guida Maurizio, Locci Mariavittoria, Zullo Fulvio, Berghella Vincenzo
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
J Matern Fetal Neonatal Med. 2020 Oct;33(19):3368-3376. doi: 10.1080/14767058.2019.1571576. Epub 2019 Jan 31.
Postpartum hemorrhage (PPH) is responsible for about 25% of maternal deaths worldwide. Antifibrinolytic agents, mainly tranexamic acid, have been demonstrated to reduce maternal blood loss and need for transfusion requirements at delivery in some settings. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effectiveness of tranexamic acid for the prevention of PPH after vaginal delivery. The search was conducted using electronic databases from the inception of each database through February 2018. Review of articles also included the abstracts of all references retrieved from the search. No restrictions for language or geographic location were applied. Selection criteria included RCTs comparing the prophylactic use of tranexamic acid after vaginal delivery with control (either placebo or no treatment). Trials in women undergoing cesarean delivery and trials in women with established PPH were excluded. The primary outcome was the incidence of primary PPH. The summary measures were reported as summary relative risk (RR) with 95% confidence interval (CI) using the random-effects model of DerSimonian and Laird. Four RCTs, including 4671 participants, evaluating tranexamic acid usually 1 g intravenous (IV) within 10 min after vaginal delivery in addition to oxytocin, cord traction, and uterine massage, at or near term for prevention of primary PPH, defined mostly as blood loss ≥500 mL in the first 24 h following delivery, were analyzed. Women who received prophylactic tranexamic acid after vaginal delivery had a significantly lower incidence of primary PPH (8.7 versus 11.4%; RR 0.61, 95% CI 0.41-0.91) and lower mean blood loss mean difference (MD) -84.74 mL, 95% CI -109.76 to -59.72). The risk of thrombotic events was not increased in the tranexamic acid group. Prophylactic tranexamic acid 1 g IV within 10 min after vaginal delivery reduces the risk of primary PPH.
产后出血（PPH）导致了全球约25%的孕产妇死亡。抗纤溶药物，主要是氨甲环酸，已被证明在某些情况下可减少产妇失血以及分娩时的输血需求。这项随机对照试验（RCT）的荟萃分析旨在评估氨甲环酸预防阴道分娩后PPH的有效性。检索使用了从每个数据库建立至2018年2月的电子数据库。文章综述还包括从检索中获取的所有参考文献的摘要。未对语言或地理位置进行限制。选择标准包括比较阴道分娩后氨甲环酸预防性使用与对照（安慰剂或不治疗）的RCT。排除剖宫产妇女的试验以及已发生PPH妇女的试验。主要结局是原发性PPH的发生率。汇总测量结果报告为采用DerSimonian和Laird随机效应模型的汇总相对风险（RR）及95%置信区间（CI）。分析了四项RCT，共4671名参与者，评估了在阴道分娩后10分钟内通常静脉注射1克氨甲环酸，联合缩宫素、脐带牵引和子宫按摩，在足月或接近足月时预防原发性PPH的效果，原发性PPH大多定义为分娩后24小时内失血≥500毫升。阴道分娩后接受预防性氨甲环酸的妇女原发性PPH发生率显著较低（8.7%对11.4%；RR 0.61，95% CI 0.41 - 0.91），平均失血量均值差异较低（MD）-84.74毫升，95% CI -109.76至-59.72）。氨甲环酸组血栓形成事件的风险未增加。阴道分娩后10分钟内静脉注射1克预防性氨甲环酸可降低原发性PPH的风险。
