■这项研究检查了拉下子宫颈并将其填入阴道穹窿(PC-PVF)对子宫下段产后出血(PPH-LUS)的疗效。
对2019年1月至2022年12月在两家三级医院阴道分娩后的所有PPH-LUS病例进行回顾性调查。保守治疗成功的患者仅分为常规治疗(40例),常规治疗+早期PC-PVF(33例),常规治疗+晚期PC-PVF(51例)组。常规治疗包括子宫按摩,子宫内膜,和氨甲环酸给药。通过比较分娩后24h内的出血量和出血率来评估治疗效果。
■总共124例患者接受了保守治疗,除了3例因子宫下段不完全破裂而在PC-PVF失败后进行剖腹止血的患者。仅常规治疗的疗效为44%(40/91),与PC-PVF联合用于PPH-LUS的疗效为100%。产妇年龄差异无统计学意义,孕周,新生儿体重,和阿普加得分。但常规治疗+早期PC-PVF组的总失血量(657.27ml±131.61ml)明显低于其他两组,分别为847.13ml±250.37ml(p<0.01)和1040.78ml±242.70ml(p<0.01),分别。常规治疗+早期PC-PVF组填塞后出血率明显下降。
■PC-PVF是PPH-LUS的安全有效治疗方法。早期识别PPH-LUS并及时应用PC-PVF可有效减少阴道分娩后的失血量。
产后出血严重威胁孕产妇安全,仍是孕产妇死亡的主要原因。目前,阴道分娩后缺乏对PPH-LUS的早期识别和有针对性的保守治疗.仍然非常需要治疗PPH-LUS的创新,因为,根据目前可用的管理策略,结果仍然不一致,增加并发症的风险,基层医院的准入有限。根据临床数据统计和比较,事实证明,PC-PVF是一种简单的,快速,本研究采用非侵入性方法治疗阴道分娩后的PPH-LUS。由于其简单的技术要求,易于获取的材料,成本低,PC-PVF适用于各级医院。
UNASSIGNED: This study examined the efficacy of pulling down the cervix and packing it in the vaginal fornix (PC-PVF) on postpartum hemorrhage in the lower uterine segment (PPH-LUS).
UNASSIGNED: All cases of PPH-LUS after vaginal delivery at two tertiary hospitals between January 2019 and December 2022 were retrospectively investigated. Patients treated successfully with conservative measures were divided into routine treatment only (40 patients), routine treatment + early PC-PVF (33 patients), and routine treatment + late PC-PVF (51 patients) groups. Routine treatment consisted of uterine massage, uterotonics, and tranexamic acid administration. The therapeutic effect was evaluated by comparing the volume and rate of bleeding within 24 h after delivery.
UNASSIGNED: A total of 124 patients were treated conservatively, except for three patients who underwent laparotomy for hemostasis after PC-PVF failed for incomplete rupture of the lower uterine segment. The efficacy of treatment was 44% (40/91) for routine treatment only and 100% when combined with PC-PVF for PPH-LUS. There was no significant difference in maternal age, gestational week, neonatal weight, and Apgar score. But the total blood loss in the conventional treatment + early PC-PVF group (657.27 ml ± 131.61 ml) was significantly lower than that in the other two groups, which was 847.13 ml ± 250.37 ml(p < .01) and 1040.78 ml ± 242.70 ml (p < .01), respectively. The bleeding rate in the routine treatment + early PC-PVF group decreased significantly after tamponade.
UNASSIGNED: PC-PVF is a safe and effective treatment for PPH-LUS. Early identification of PPH-LUS and prompt application of PC-PVF can effectively reduce blood loss after vaginal delivery.
Postpartum hemorrhage is a serious threat to maternal safety and remains to be the leading cause of maternal death. At present, there is a lack of early identification and targeted conservative treatment of PPH-LUS after vaginal delivery. Innovations for the treatment of PPH-LUS are still greatly needed because, with currently available management strategies, there is still inconsistency in outcomes, increased risk of complications, and limited access in primary hospitals. Based on clinical data statistics and comparison, it is proved that PC-PVF is a simple, rapid, and noninvasive method for the treatment of PPH-LUS after vaginal delivery in this study. Because of its simple technical requirements, easily accessible materials, and low cost, PC-PVF is suitable for hospitals at all levels.