目的:我们研究的主要目的是检查四种不同的预防方案对预防阴道分娩后产后出血的影响。只包括卡贝缩宫素,只有催产素,以及卡β素或催产素与氨甲环酸的组合。
方法:多中心随机对照试验。
方法:参与者/材料,设置,和方法:这项多中心前瞻性随机对照试验于2022年8月至2023年1月在Bezmialem大学妇产科和VanHealth教学研究医院进行。收集的数据包括年龄,妊娠,奇偶校验,出生时的胎龄,交付阶段的持续时间,产前血红蛋白和血细胞比容浓度,血红蛋白和血细胞比容浓度的变化,产时失血,阴道分娩2h后估计失血,Apgar得分在1和5分钟,出生体重,和新生儿重症监护病房(NICU)入院。使用带有校准袋的产后悬垂物以毫升为单位客观地测量了产时失血量。在分娩后2小时内,通过减去放置在患者病床下的垫的空重量来测量出血量。I组:卡贝缩宫素100mcg/ml(n=75),II组:催产素5IU/ml(n=75),第三组:卡贝缩宫素和氨甲环酸50mg/ml(n=75),IV组:催产素和氨甲环酸(n=75)结果:两组之间血红蛋白浓度显着降低(分别为1.03±1.04、1.3±0.85、1.4±0.85、1.41±0.87;p<0.001)。组4具有最高的血红蛋白和血细胞比容浓度的降低。当我们调查亚组差异时,第2组的血红蛋白浓度下降明显高于第1组(1.30±0.85vs.1.03±1.04;p=0.023),第2组比第3组(1.30.85vs.1.04±0.9;p=0.013),并且在第4组中比第3组(1.41±0.87vs.1.04±0.9;p0,001)(表2)。血细胞比容水平的降低在组间有显著差异(分别为3.07±3.23、3.55±2.44、2.13±3.09、4.25±2.52;p<0.001)。四组之间的平均失血量没有显着差异(分别为277.19±208.10、294.13±198.64、274.33±199.57和283.97±178.11;p=0.445)。此外,两组之间的输血需求率没有显着差异(1.3%,5.4%,4%,4%,分别为;p=0.6)。
结论:这项研究最重要的限制是参与者数量相对较少。
结论:结论:我们的研究结果表明,卡贝缩宫素在降低产后血红蛋白方面可能比缩宫素和缩宫素加氨甲环酸方案更成功,而且在阴道分娩后用于预防产后出血方面,在输血需求方面没有差异.
OBJECTIVE: Our study\'s primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including
carbetocin only, oxytocin only, and a combination of
carbetocin or oxytocin with tranexamic acid.
METHODS: A multicentric randomized controlled trial.
METHODS: This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient\'s bed within 2 h after delivery. Group I:
carbetocin 100 μg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III:
carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75).
RESULTS: The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6).
CONCLUSIONS: The most important limitation of the study is a relatively small number of participants.
CONCLUSIONS: In conclusion, our findings suggest that
carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery.