Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xingtai Medical College, Xingtai City, Hebei Province, China.
Medicine (Baltimore). 2024 Mar 15;103(11):e37533. doi: 10.1097/MD.0000000000037533.
To investigate the effect of Bakri balloon tamponade (BBT) combined with different suture methods on preventing postpartum hemorrhage in women with pregnancy-induced hypertension (PIH) undergoing cesarean delivery (CD).
This randomized, double-blind, controlled trial was conducted at The First Affiliated Hospital of Xingtai Medical College from October 2020 to June 2023. Patients with PIH who had persistent bleeding after CD and were unresponsive to uterine contractions, sutures, or uterine disconnection procedures were eligible participants. Eligible participants were randomly assigned to control and study groups, with 50 patients in each group. The control group used BBT combined with B-lynch uterine compression sutures, while the study group used BBT combined with modified Hayman suture. Intraoperative and postoperative bleeding and changes in vital signs were compared between the 2 groups. Moreover, changes in inflammation levels, coagulation function, and sex hormone levels were compared between the 2 groups before and after surgery.
A total of 122 patients with persistent bleeding after CD were recruited, of whom 22 were excluded (16 cases of uterine contractions and/or local uterine myometrial sutures for hemostasis, 4 cases of preoperative uterine artery embolization, and 2 cases of uterine malformations). The intraoperative blood loss, postoperative blood loss at 2 hours, postoperative blood loss at 24 hours, and decrease in red blood cell and hemoglobin in the study group were significantly lower than those in the control group (P < .05). After surgery, the levels of inflammation, coagulation function, and sex hormone in both groups improved compared to before surgery, and the study group was significantly better than the control group (P < .05). In addition, the incidence of postoperative adverse events in the study group was significantly lower than that in the control group (P < .05).
The hemostatic effect of BBT combined with B-lynch uterine compression sutures is comparable to that of BBT combined with modified Hayman suture for postpartum hemorrhage in pregnant women with PIH undergoing CD, but the latter has less blood loss, attenuated inflammatory response, reduced impact on coagulation function and ovarian function, and a lower incidence of adverse events.
探讨 Bakri 球囊填塞（BBT）联合不同缝合方法对预防妊娠高血压（PIH）剖宫产产后出血的效果。
本随机、双盲、对照试验于 2020 年 10 月至 2023 年 6 月在邢台市第一医院进行。对于行剖宫产术（CD）后持续出血且对子宫收缩、缝合或子宫切开术无反应的 PIH 患者，符合纳入标准。符合条件的患者被随机分配到对照组和研究组，每组 50 例。对照组采用 BBT 联合 B-Lynch 子宫压迫缝合术，研究组采用 BBT 联合改良 Hayman 缝合术。比较两组患者术中及术后出血量和生命体征变化，比较两组患者手术前后炎症水平、凝血功能和性激素水平的变化。
共纳入 122 例 CD 后持续出血患者，其中 22 例排除（16 例为子宫收缩和/或局部子宫肌层缝合止血，4 例为术前子宫动脉栓塞，2 例为子宫畸形）。研究组术中出血量、术后 2 小时出血量、术后 24 小时出血量、红细胞和血红蛋白下降量均明显低于对照组（P ＜0.05）。术后两组炎症、凝血功能和性激素水平均较术前改善，且研究组明显优于对照组（P ＜0.05）。此外，研究组术后不良事件发生率明显低于对照组（P ＜0.05）。
BBT 联合 B-Lynch 子宫压迫缝合术与 BBT 联合改良 Hayman 缝合术治疗 PIH 剖宫产产后出血的止血效果相当，但后者出血量较少，炎症反应较轻，对凝血功能和卵巢功能的影响较小，不良事件发生率较低。
