Gazvani M R, Luckas M J, Drakeley A J, Emery S J, Alfirevic Z, Walkinshaw S A
Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, United Kingdom.
Obstet Gynecol. 1998 Feb;91(2):203-7. doi: 10.1016/s0029-7844(97)00622-4.
To evaluate the ability of intraumbilical oxytocin injection as a treatment for retained placenta after vaginal delivery to reduce the incidence of manual removal and postpartum hemorrhage.
A randomized controlled trial was set up in a university and a district general hospital. We recruited 81 women with singleton pregnancies who underwent vaginal delivery and who failed to deliver the placenta after 20 minutes of active management of the third stage of labor. Study subjects were randomized to receive either 1) an intraumbilical injection of oxytocin (20 IU in 20 mL of saline); 2) an intraumbilical injection of saline (20 mL); or 3) no treatment. Outcome measures were expulsion of the placenta within 45 minutes of delivery, need for manual removal of the placenta under anesthesia, and postpartum hemorrhage (defined as a blood loss greater than 500 mL).
Women given an intraumbilical injection of oxytocin had a significant increase in spontaneous expulsion of the placenta within 45 minutes of delivery and fewer manual removals of the placenta, compared with women without treatment (odds ratio [OR] 11.6, 99% confidence interval [CI] 1.4, 272.8; and OR 7.4, 99% CI 1.1, 86.5; respectively). When women given intraumbilical oxytocin were compared with women given only intraumbilical saline, the difference was not statistically significant (OR 6.6, 99% CI 0.9, 77.2 for spontaneous expulsion of the placenta; and OR 4.7, 99% CI 0.8, 39.5 for manual removal). There was no significant difference in the incidence of spontaneous expulsion and manual removal of the placenta between women given intraumbilical saline injection and women without treatment (OR 1.8, 99% CI 0.1, 53.9; and OR 1.6, 99% CI 0.1, 22.4; respectively).
The results of our study suggest a clinically important beneficial effect of intraumbilical oxytocin injection in the management of retained placenta.
评估脐内注射缩宫素治疗阴道分娩后胎盘滞留以降低人工剥离胎盘和产后出血发生率的能力。
在一所大学医院和一家区级综合医院开展了一项随机对照试验。我们招募了81名单胎妊娠且经阴道分娩、在第三产程积极处理20分钟后仍未娩出胎盘的女性。研究对象被随机分为三组：1）脐内注射缩宫素（20 IU溶于20 mL生理盐水中）；2）脐内注射生理盐水（20 mL）；3）不进行治疗。观察指标包括分娩后45分钟内胎盘娩出情况、麻醉下人工剥离胎盘的必要性以及产后出血（定义为失血量超过500 mL）。
与未接受治疗的女性相比，脐内注射缩宫素的女性在分娩后45分钟内胎盘自然娩出的比例显著增加，且人工剥离胎盘的情况较少（比值比[OR]分别为11.6，99%置信区间[CI] 1.4，272.8；以及OR 7.4，99% CI 1.1，86.5）。将脐内注射缩宫素的女性与仅脐内注射生理盐水的女性进行比较时，差异无统计学意义（胎盘自然娩出的OR为6.6，99% CI 0.9，77.2；人工剥离的OR为4.7，99% CI 0.8，39.5）。脐内注射生理盐水的女性与未接受治疗的女性在胎盘自然娩出和人工剥离的发生率上无显著差异（OR分别为1.8，99% CI 0.1，53.9；以及OR 1.6，99% CI 0.1，22.4）。
我们的研究结果表明脐内注射缩宫素在处理胎盘滞留方面具有临床上重要的有益效果。
