Norris T C
Department of Family Medicine, University of Kansas Medical Center, Kansas City 66160-7370, USA.
Am Fam Physician. 1997 Feb 1;55(2):635-40.
Postpartum hemorrhage remains a source of maternal morbidity and mortality in modern obstetric medicine. While the risk factors for postpartum hemorrhage are well described, many patients who develop this complication have no known antenatal risk factors. Therefore, in every delivery the attending physician must be vigilant for signs of hemorrhage. Paramount to a successful outcome is the efficient enactment of a logical plan. Uterine atony causes more than 90 percent of cases of postpartum hemorrhage. Lower genital tract lacerations and retained placental products are the most common causes of hemorrhage when the uterus is firm. Successful treatment of postpartum hemorrhage requires the prompt recognition of ongoing bleeding, followed by uterine massage and oxytocin administration. The intramuscular administration of ergot or prostaglandin preparations can help with refractory bleeding. Most deaths from postpartum hemorrhage occur not because of brisk blood loss, but because of the ineffective management of continuous low-level bleeding.
产后出血仍然是现代产科医学中孕产妇发病和死亡的一个原因。虽然产后出血的危险因素已得到充分描述，但许多发生这种并发症的患者并无已知的产前危险因素。因此，在每次分娩时，主治医生必须警惕出血迹象。成功治疗的关键在于有效实施合理的计划。宫缩乏力导致超过90%的产后出血病例。当子宫收缩良好时，下生殖道裂伤和胎盘组织残留是出血的最常见原因。成功治疗产后出血需要迅速识别持续出血，随后进行子宫按摩并给予催产素。肌肉注射麦角制剂或前列腺素制剂有助于治疗难治性出血。大多数产后出血死亡并非由于大量失血，而是由于对持续性少量出血处理不当。
