PDF(Pubmed)
Abstract：
BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. PPH-preventing interventions need to be prioritized and can be integrated with conventional methods of PPH prevention. The introduction of negative intrauterine pressure using a suction cannula can be one of the cheapest modalities to decrease PPH secondary to uterine atonicity. This method has brought a renaissance to practical obstetrics in low-middle income countries (LMIC), where the cost and availability of uterotonics are major health issues.
METHODS: It was a prospective quality improvement (QI) study conducted in the labor and delivery wards of a tertiary care medical institute and teaching center over the duration of one year. We aimed to assess the decrease in the incidence of atonic PPH with a negative intrauterine pressure suction device (NIPSD) integrated with active management of the third stage of labor (AMTSL) in the prevention of atonic PPH following normal vaginal delivery in low-risk antenatal women. In the initial six months, routine AMTSL was instituted for all consenting women (group 1). In the next six months, NIPSD was integrated with AMTSL (group 2). Data pertaining to the amount of blood loss, the incidence of primary PPH, uterine tone, fall in hemoglobin and hematocrit levels post-delivery, need for blood transfusion, and doctor and patient satisfaction were tabulated for all patients.
RESULTS: A total of 1324 consenting women were eligible for enrollment during the study time frame. In the initial six months (baseline period, group 1), 715 participants were subjected to routine AMTSL in the third stage of labor. During the intervention phase (group 2), 609 parturient women were recruited. There was no significant difference in baseline parameters between the two groups. With the introduction of NIPSD to routine AMTSL, there was a significant decrease in the average volume of blood loss during vaginal delivery (group 1 = 389.45+65.42 ml, group 2 = 216.66+34.27 ml; p-value = 0.012). The incidence of atonic PPH was reduced by more than 75% (group 1 = 13 women, group 2 = 3 women; p-value = 0.001) after the introduction of NIPSD complementing routine AMTSL. The introduction of NIPSD has also been instrumental in reducing the cost burden on patient and hospital expenditures. The net benefit of its introduction resulted in a reduction of the overall cost burden of blood transfusions by around 70%.
CONCLUSIONS: PPH is a public health problem, and measures to reduce PPH must be implemented to decrease this health burden. In countries with low resources, complementing routine AMTSL with NIPSD can be instrumental in decreasing the incidence of PPH. Considering its cost-effectiveness and reusability, LMIC can adopt NIPSD as a routine measure in all vaginal deliveries.
METHODS: It was a prospective quality improvement (QI) study conducted in the labor and delivery wards of a tertiary care medical institute and teaching center over the duration of one year. We aimed to assess the decrease in the incidence of atonic PPH with a negative intrauterine pressure suction device (NIPSD) integrated with active management of the third stage of labor (AMTSL) in the prevention of atonic PPH following normal vaginal delivery in low-risk antenatal women. In the initial six months, routine AMTSL was instituted for all consenting women (group 1). In the next six months, NIPSD was integrated with AMTSL (group 2). Data pertaining to the amount of blood loss, the incidence of primary PPH, uterine tone, fall in hemoglobin and hematocrit levels post-delivery, need for blood transfusion, and doctor and patient satisfaction were tabulated for all patients.
RESULTS: A total of 1324 consenting women were eligible for enrollment during the study time frame. In the initial six months (baseline period, group 1), 715 participants were subjected to routine AMTSL in the third stage of labor. During the intervention phase (group 2), 609 parturient women were recruited. There was no significant difference in baseline parameters between the two groups. With the introduction of NIPSD to routine AMTSL, there was a significant decrease in the average volume of blood loss during vaginal delivery (group 1 = 389.45+65.42 ml, group 2 = 216.66+34.27 ml; p-value = 0.012). The incidence of atonic PPH was reduced by more than 75% (group 1 = 13 women, group 2 = 3 women; p-value = 0.001) after the introduction of NIPSD complementing routine AMTSL. The introduction of NIPSD has also been instrumental in reducing the cost burden on patient and hospital expenditures. The net benefit of its introduction resulted in a reduction of the overall cost burden of blood transfusions by around 70%.
CONCLUSIONS: PPH is a public health problem, and measures to reduce PPH must be implemented to decrease this health burden. In countries with low resources, complementing routine AMTSL with NIPSD can be instrumental in decreasing the incidence of PPH. Considering its cost-effectiveness and reusability, LMIC can adopt NIPSD as a routine measure in all vaginal deliveries.
摘要：
背景：产后出血（PPH）是全球孕产妇死亡的主要原因。PPH预防干预措施需要优先考虑，并可以与PPH预防的常规方法相结合。使用抽吸套管引入宫内负压可能是减少继发于子宫失调的PPH的最便宜的方式之一。这种方法给中低收入国家(LMIC)的实际产科带来了复兴，宫缩剂的成本和可用性是主要的健康问题。
方法：这是一项前瞻性质量改进（QI）研究，在三级医疗机构和教学中心的产程和分娩病房进行了为期一年的研究。我们的目的是评估宫内负压吸引装置（NIPSD）与第三产程（AMTSL）的积极管理相结合，以预防低危产前妇女正常阴道分娩后失稳PPH的发生率降低。在最初的六个月里，为所有同意的妇女制定常规AMTSL（第1组）。在接下来的六个月里，NIPSD与AMTSL整合（第2组）。失血量的相关数据,原发性PPH的发病率，子宫张力,分娩后血红蛋白和血细胞比容水平下降，需要输血,并对所有患者的医生和患者满意度进行了列表。
结果：在研究时间范围内，共有1324名同意的女性符合入选条件。在最初的六个月(基线期，组1),715名参与者在第三产程接受常规AMTSL。在干预阶段（第2组），招募了609名产妇。两组之间的基线参数没有显着差异。随着NIPSD引入常规AMTSL，阴道分娩期间平均失血量显著减少(第1组=389.45+65.42ml,第2组=216.66+34.27ml；p值=0.012）。无张力PPH的发生率降低了75%以上（第1组=13名女性，第2组=3名女性；p值=0.001）在引入NIPSD补充常规AMTSL后。NIPSD的引入也有助于减少患者和医院支出的成本负担。其引入的净收益导致输血的总成本负担减少了约70%。
结论：PPH是一个公共卫生问题，并且必须实施减少PPH的措施以减轻这种健康负担。在资源匮乏的国家，用NIPSD补充常规AMTSL可能有助于降低PPH的发生率。考虑到其成本效益和可重用性，LMIC可以在所有阴道分娩中采用NIPSD作为常规措施。
方法：这是一项前瞻性质量改进（QI）研究，在三级医疗机构和教学中心的产程和分娩病房进行了为期一年的研究。我们的目的是评估宫内负压吸引装置（NIPSD）与第三产程（AMTSL）的积极管理相结合，以预防低危产前妇女正常阴道分娩后失稳PPH的发生率降低。在最初的六个月里，为所有同意的妇女制定常规AMTSL（第1组）。在接下来的六个月里，NIPSD与AMTSL整合（第2组）。失血量的相关数据,原发性PPH的发病率，子宫张力,分娩后血红蛋白和血细胞比容水平下降，需要输血,并对所有患者的医生和患者满意度进行了列表。
结果：在研究时间范围内，共有1324名同意的女性符合入选条件。在最初的六个月(基线期，组1),715名参与者在第三产程接受常规AMTSL。在干预阶段（第2组），招募了609名产妇。两组之间的基线参数没有显着差异。随着NIPSD引入常规AMTSL，阴道分娩期间平均失血量显著减少(第1组=389.45+65.42ml,第2组=216.66+34.27ml；p值=0.012）。无张力PPH的发生率降低了75%以上（第1组=13名女性，第2组=3名女性；p值=0.001）在引入NIPSD补充常规AMTSL后。NIPSD的引入也有助于减少患者和医院支出的成本负担。其引入的净收益导致输血的总成本负担减少了约70%。
结论：PPH是一个公共卫生问题，并且必须实施减少PPH的措施以减轻这种健康负担。在资源匮乏的国家，用NIPSD补充常规AMTSL可能有助于降低PPH的发生率。考虑到其成本效益和可重用性，LMIC可以在所有阴道分娩中采用NIPSD作为常规措施。
