WONCA研究论文摘要汇编——控制性脐带牵引法预防第三产程产后出血的有效性研究:多中心随机对照试验

发布时间：2018-09-06 20:16

【摘要】：目的探讨脐带牵引对产后出血发生率的影响并对条件好的医疗设施中分娩第三产程的其他特性做出评价。设计随机对照试验。场所法国5家大学妇产医院。参试者入选者条件:年龄≥18岁;单胎;妊娠≥35周;准备经阴道分娩。干预措施将入选者随机分组:分娩第三产程脐带牵引组或标准胎盘娩出组(在帮助胎盘娩出前先等待胎盘自然娩出)。两组入选女性分娩后均接受催产素预防性注射。主要结果测量将收集袋中血液≥500 ml视为产后出血并计算发生率。结果就产后出血发生率而言,控制性脐带牵引组(9.8%,196/2 005)与标准胎盘娩组(10.3%,206/2 008)之间无差异〔相关风险0.95,95%CI(0.79,1.15)〕。需用手推帮助胎盘娩出,控制性脐带牵引组(4.2%,85/2 033)比标准胎盘娩出组(6.1%,123/2 024)的明显要少〔相关风险0.69,95%CI(0.53,0.90)〕;控制性脐带牵引组中第三产程15 min的人数明显少于标准胎盘娩出组〔分别为4.5%,91/2 030和14.3%,289/2 020,相关风险0.31,95%CI(0.25,0.39)〕。第三产程期间所报告的疼痛程度和不舒服感,控制性脐带牵引组女性明显低于标准胎盘娩出组。两组均未发生子宫内翻。结论条件好的医疗单位,胎盘娩出管理中采用控制性脐带牵引对产后出血的发生率和其他产后失血标记并无明显作用。用控制性脐带牵引法预防产后出血还缺乏证据。
[Abstract]:Objective To investigate the effect of umbilical cord traction on the incidence of postpartum hemorrhage and to evaluate the other characteristics of the third stage of delivery in well-equipped medical facilities. Patients were randomly divided into two groups: umbilical cord traction group or standard placenta delivery group (waiting for natural placenta delivery before assisting placenta delivery). Both groups received prophylactic oxytocin injection after delivery. In terms of incidence, there was no significant difference between the controlled umbilical cord traction group (9.8%, 196/2 005) and the standard placenta delivery group (10.3%, 206/2 008) [the associated risk was 0.95, 95% CI (0.79, 1.15)]. The controlled umbilical cord traction group (4.2%, 85/2 033) was significantly less than the standard placenta delivery group (6.1%, 123/2 024)] [the associated risk was 0.69, 95% CI (0.79%, 1.15%). (0.53,0.90)] The number of women in the controlled umbilical cord traction group at 15 minutes of the third stage of labor was significantly less than that in the standard placental delivery group [4.5%, 91/2030 and 14.3%, 289/2 020, respectively, with a risk of 0.31,95% CI (0.25,0.39)]. The pain and discomfort reported during the third stage of labor in the controlled umbilical cord traction group was significantly lower than that in the standard placental delivery group. Conclusion Controlled umbilical cord traction has no significant effect on the incidence of postpartum hemorrhage and other markers of postpartum hemorrhage in the management of placenta delivery. There is no evidence to prevent postpartum hemorrhage by controlled umbilical cord traction.
【作者单位】：中国石油天然气集团公司中心医院;
【分类号】：R714.461

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