Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida.
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
Am J Perinatol. 2023 Nov;40(15):1644-1650. doi: 10.1055/s-0041-1739409. Epub 2021 Nov 14.
This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery.
This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage.
A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin ( = 0.79).
There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery.
· Transabdominal uterine compression and uterine massage are appropriate to prevent postpartum hemorrhage.. · No significant difference in blood loss or maternal discomfort observed between the two techniques.. · Both methods are equally effective and either one can be used based on provider preference..
本研究旨在比较持续性子宫压迫与子宫按摩在减少阴道分娩后出血方面的效果。
这是一项在美国贝鲁特美国大学医学中心（AUBMC）于 2015 年 10 月至 2017 年 10 月期间进行的前瞻性随机试验。纳入标准为：单胎妊娠，孕周≥36 周，既往分娩次数<3 次，适合阴道分娩。参与者被随机分为两组，持续性子宫压迫组（组 1）和子宫按摩组（组 2）。产后出血（出血量≥500mL）的发生率为主要结局。我们假设本机构的产后出血发生率与之前发表的研究相似。每组需要 545 名女性，以检测主要结局（产后出血发生率）从 9.6%降低至 4.8%（降低 50%），单侧α值为 0.05，效能为 80%。考虑到 10%的脱落率。次要结局包括入住重症监护病房（ICU）、产后并发症、血红蛋白下降、住院时间、产妇疼痛、使用宫缩剂或产后出血的手术治疗。
共招募了 550 名孕妇，其中组 1 273 名，组 2 277 名。两组间基线特征无统计学差异。麻醉类型、会阴切开率、裂伤程度和平均出生体重在两组间也相同。两组间主要结局发生率无差异（组 1：15.5%，组 2：15.4%； = 0.98）。两组间的其他次要结局也无统计学差异，包括血红蛋白下降（ = 0.79）。
阴道分娩后持续性子宫压迫与子宫按摩的出血量无差异。
· 经腹子宫压迫和子宫按摩均适用于预防产后出血。· 两种技术在出血量或产妇不适方面无显著差异。· 两种方法均有效，可根据提供者偏好选择。
