Department of Obstetrics and Gynecology, Acıbadem University Atakent Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, Health Sciences University, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey.
Arch Gynecol Obstet. 2024 Jun;309(6):2689-2695. doi: 10.1007/s00404-023-07211-5. Epub 2023 Sep 12.
The aim of this study was to investigate the effects of uterine massage performed before placental delivery on the third stage of labor and postpartum hemorrhage after vaginal delivery.
The study was designed as a prospective randomized controlled study. Between June 2018 and June 2019, 242 women who gave birth in Istanbul Kanuni Sultan Suleyman Training and Research Hospital were included in the study. The women were divided into two groups; group 1 received uterine massage after vaginal delivery before placental delivery (n: 128) and group 2 did not receive massage (n: 114). Demographic characteristics, delivery times of the baby and placenta, duration of uterine massage, amount of postpartum hemorrhage and postpartum hemoglobin values of both groups were recorded.
Baseline characteristics were similar in both groups. Placental output time after delivery was 8.3 ± 4.2 min in group 1 and 13.5 ± 6.3 min in group 2. The third stage of labor was significantly shorter in group 1 (p = 0.012). The amount of blood loss of 500 mL or more after delivery was higher in group 2 but not statistically different (p > 0.05). Hemoglobin value measured within 12-24 h after delivery was significantly lower in group 2 (hemoglobin < 8 g/dL after 12-24 h p = 0.003; hemoglobin < 10 g/dL after 12-24 h p = 0.001). Delta hb value was also significantly lower in group 2 (p = 0.03). With this result, it was determined that bleeding intense enough to require transfusion was more common in group 2.
In patients delivering vaginally, uterine massage before placental delivery shortens the placental delivery time and reduces postpartum hemorrhage. In addition to oxytocin and controlled cord traction to reduce postpartum blood loss, uterine massage should be routinely used in the active management of the third stage of labor.
NCT03858569.
本研究旨在探讨胎盘娩出前进行子宫按摩对阴道分娩产妇第三产程及产后出血的影响。
本研究设计为前瞻性随机对照研究。2018 年 6 月至 2019 年 6 月，共有 242 名在伊斯坦布尔 Kanuni Sultan Suleyman 培训和研究医院分娩的妇女被纳入研究。将这些妇女分为两组；组 1 在阴道分娩后胎盘娩出前进行子宫按摩（n=128），组 2 未进行按摩（n=114）。记录两组的人口统计学特征、婴儿和胎盘的分娩时间、子宫按摩时间、产后出血量和产后血红蛋白值。
两组的基线特征相似。组 1 的胎盘娩出时间为 8.3±4.2 分钟，组 2 为 13.5±6.3 分钟。组 1 的第三产程明显缩短（p=0.012）。组 2 产后出血量≥500ml 者较多，但无统计学差异（p＞0.05）。组 2 产后 12-24 小时内测量的血红蛋白值明显较低（产后 12-24 小时血红蛋白＜8g/dL，p=0.003；产后 12-24 小时血红蛋白＜10g/dL，p=0.001）。组 2 的 delta hb 值也明显较低（p=0.03）。结果表明，组 2 需要输血的出血较为常见。
在阴道分娩的患者中，胎盘娩出前进行子宫按摩可缩短胎盘娩出时间并减少产后出血。除缩宫素和控制性脐带牵引以减少产后失血外，子宫按摩应常规用于第三产程的积极管理。
NCT03858569。
