Mitchell G G, Elbourne D R
Hope Hospital, Salford, United Kingdom.
Online J Curr Clin Trials. 1993 Aug 13;Doc No 83:[2305 words; 32 paragraphs].
To compare oxytocin plus ergometrine against oxytocin alone, when administered as part of the active management of the 3rd stage of labor, in terms of postpartum hemorrhage and manual removal of the placenta.
A double-blind, randomized controlled trial.
A university teaching hospital: Hope Hospital, Salford.
All women delivering in the hospital over the period of the trial, except those for whom a cesarean section was planned, or who had significant hypertension or cardiac disease.
Syntometrine (5 units of oxytocin with 0.5 mg of ergometrine) versus 5 units of Syntocinon (oxytocin), both given by intramuscular injection with delivery of the anterior shoulder.
Postpartum blood loss, the length of the 3rd stage of labor, and the need for manual removal of the placenta.
Four hundred sixty-one women were recruited, 230 allocated to ergometrine plus oxytocin and 231 to oxytocin alone. The duration of the 3rd stage of labor in each group was similar (difference in means 0.2 mins; 95% confidence interval [CI], -1.0 to 1.5) and the need for manual removal of the placenta (odds ratio [OR] 1.21; 95% CI, 0.37 to 4.00). There was less postpartum blood loss in the oxytocin plus ergometrine group, reflected in the lower incidence of primary postpartum hemorrhage (> 500 mL) (OR 0.37; 95% CI, 0.16 to 0.85).
Judged on the basis of this trial alone, oxytocin plus ergometrine is more effective than oxytocin alone in the prevention of postpartum hemorrhage. However, evidence from other trials shows that the ergometrine component not uncommonly has side effects of nausea, vomiting, and raised blood pressure. The implications for practice therefore depend on the relative weights placed on these competing risks by women and clinicians. Further research is needed to quantify these along with research into possible differential effects on longer-term outcomes and into the implications of a higher dose of oxytocin.
在分娩第三产程的积极处理中，比较缩宫素加麦角新碱与单用缩宫素在产后出血和人工剥离胎盘方面的效果。
双盲随机对照试验。
一所大学教学医院：索尔福德希望医院。
试验期间在该医院分娩的所有妇女，但计划剖宫产者、患有严重高血压或心脏病者除外。
用合成宫缩素（含5单位缩宫素和0.5毫克麦角新碱）与5单位缩宫素（催产素）进行比较，均在胎头前肩娩出时肌内注射。
产后失血量、第三产程时长以及人工剥离胎盘的必要性。
招募了461名妇女，230名分配至麦角新碱加缩宫素组，231名分配至单用缩宫素组。每组第三产程的时长相似（均值差异0.2分钟；95%置信区间[CI]，-1.0至1.5），人工剥离胎盘的必要性（优势比[OR]1.21；95%CI，0.37至4.00）。缩宫素加麦角新碱组的产后失血量较少，表现为原发性产后出血（>500毫升）的发生率较低（OR 0.37；95%CI，0.16至0.85）。
仅基于该试验判断，缩宫素加麦角新碱在预防产后出血方面比单用缩宫素更有效。然而，其他试验的证据表明，麦角新碱成分常有恶心、呕吐和血压升高等副作用。因此，对实践的影响取决于女性和临床医生对这些相互竞争风险的相对重视程度。需要进一步研究来量化这些风险，同时研究其对长期结局可能存在的不同影响以及更高剂量缩宫素的影响。
