在第三产程的积极管理中,比较肌肉注射甲地孕酮、直肠注射米索前列醇和小剂量静脉注射催产素。

Ruchi Jain, Sudesh Agrawal, Kamala Verma, Aastha Jain, Mayank Baid
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引用次数: 0

摘要

目的:第三产程(AMTSL)的积极管理是预防产后出血(PPH)的关键干预措施,而产后出血仍是全球产妇发病率和死亡率的最常见原因。本研究的目的是从失血量、第三产程持续时间、成本效益和副作用等方面比较肌肉注射甲地孕酮、直肠注射米索前列醇和小剂量静脉注射催产素在 AMTSL 中的效果:2017年2月至2018年2月期间,产科病房收治的75名阴道分娩孕妇接受了肌肉注射甲地孕酮(0.2毫克)或直肠注射米索前列醇(400微克)或低剂量静脉注射催产素(5单位催产素加入100毫升生理盐水)进行AMTSL。数据分三组记录:A组(甲地孕酮)、B组(米索前列醇)和C组(催产素)各25例:结果:与米索前列醇(346.13 ± 58.35 mL)和催产素(334.5 ± 69.20 mL)相比,甲缩宫素组的平均失血量最少(246.87 ± 65.44 mL)(P = 0.000),甲缩宫素组的第三产程平均持续时间也最少(6.21 ± 1.58 min)(P = 0.0008):尽管甲缩龙副作用的发生率较高,如恶心、呕吐、头痛和血压升高,但它是减少第三产程失血量的最有效药物。在医疗设施有限、无法通过肠外途径给药的偏远地区,直肠米索前列醇仍是一种替代药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Comparison of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in active management of the third stage of labor.

Objective: Active management of the third stage of labor (AMTSL) is a critical intervention for the prevention of postpartum hemorrhage (PPH), which is still the most common cause of maternal morbidity and mortality worldwide. The objective of the study is to compare the effect of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in the AMTSL in terms of amount of blood loss and duration of the third stage of labor, cost-effectiveness, and side effect profile.

Materials and methods: Seventy-five pregnant patients admitted in the maternity ward for vaginal delivery from February 2017 to February 2018 received either intramuscular methylergometrine (0.2 mg) or rectal misoprostol (400 mcg) or low-dose intravenous oxytocin (5 units oxytocin in 100 mL normal saline) for AMTSL. Data were recorded in three groups: Group A (methylergometrine), Group B (misoprostol), and Group C (oxytocin) consisting of 25 cases each.

Results: Mean blood loss was found to be least in methylergometrine group (246.87 ± 65.44 mL) as compared to misoprostol (346.13 ± 58.35 mL) and oxytocin (334.5 ± 69.20 mL) (P = 0.000) Mean duration of the third stage of labor was also least in methylergometrine group (6.21 ± 1.58 min) (P = 0.0008).

Conclusion: Although methylergometrine was found to have higher incidence of side effects such as nausea, vomiting, headache, and raised blood pressure, it was found to be the most effective drug for minimizing blood loss in the third stage of labor. In remote places where healthcare facilities are limited and drugs cannot be administered by parenteral route, rectal misoprostol remains an alternative.

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