Clinical analysis of Five-step rapid hemostasis in treating postpartum hemorrhage with intractable uterine contraction in cesarean section

doi:10.3877/cma.j.issn.2095-3259.2017.01.012

Abstract

Abstract:

Objective

To explore the effectiveness and safety of Five-step rapid hemostasis in the treatment of postpartum hemorrhage with intractable uterine contraction in cesarean section.

Methods

Two hundred and eighty postpartum hemorrhage cases with intractable uterine contraction during cesarean section, who were admitted in Jiangxi Maternity and Infant Hospital, were implemented Five-step rapid hemostasis process during July 1, 2015 to June 30, 2016; and the hemostatic effect and safety were observed. Twelve cases that completed Five-step rapid hemostasis were followed up for 42 days.

Results

The hemostasis success rate of 280 postpartum hemorrhage cases with intractable uterine contraction in cesarean section was 98.5%(276/280). The 12 cases that underwent Five-step rapid hemostasis were successful in hemostasis. One case had postoperative intra-abdominal hemorrhage, and recovered after conservative treatment for 24 hours. One case was diagnosed undesirable healing of uterine incision by ultrasound at the seventh day after operation, and was recovered at the forty-second day after surgery.

Conclusion

The Five-step rapid hemostasis is the simple, rapid and effective treatment for postpartum hemorrhage with intractable uterine contraction in cesarean section.

Key words: Postpartum hemorrhage, Uterine inertia, Cesarean section, Hemostatic techniques

Jiusheng Zheng, Lingzhi Liu, Ting Shen, Zonggao Liao, Siming Xin, Yun Zhang, Zhengyi Liang, Yan Yuan. Clinical analysis of Five-step rapid hemostasis in treating postpartum hemorrhage with intractable uterine contraction in cesarean section[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2017, 06(01): 47-51.

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Figures/Tables 2

References 14

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止血措施	例数	构成比(%)	止血效果及结局
第1步	88	31.43	均成功止血
第1、2步联合	122	43.57	2例术后出血，经阴道使用Bakri球囊填塞宫腔，止血成功
第1～3步联合	27	9.64	1例术后出血，子宫动脉栓塞术，止血成功，保留子宫
第1、2、4步联合	14	5.00	均成功止血
第1～4步联合	17	6.07	1例术中止血无效，急诊子宫次全切除术
第1～5步联合	12	4.29	均止血成功

止血措施	例数	构成比(%)	止血效果及结局
第1步	88	31.43	均成功止血
第1、2步联合	122	43.57	2例术后出血，经阴道使用Bakri球囊填塞宫腔，止血成功
第1～3步联合	27	9.64	1例术后出血，子宫动脉栓塞术，止血成功，保留子宫
第1、2、4步联合	14	5.00	均成功止血
第1～4步联合	17	6.07	1例术中止血无效，急诊子宫次全切除术
第1～5步联合	12	4.29	均止血成功

序号	年龄(岁)	孕周(周)	初/经产妇	术前诊断	并发症	治疗过程		术后处理	治疗效果		新生儿
序号	年龄(岁)	孕周(周)	初/经产妇	术前诊断	并发症	用药情况	输血情况	术后处理	出血量(ml)	术后42 d随访	术后住院时间(d)	结局
1	28	39^＋1	经产妇	瘢痕子宫	正常位置胎盘部分植入	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞12 U、血浆1 000 ml、冷沉淀10 U	术后腹腔引流血液1 200 ml，经纠正贫血及补充凝血因子，出血停止	3 000	痊愈	12	正常
2	26	38^＋6	初产妇	体外受精妊娠、胎膜早破	胎盘粘连	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞7.5 U、血浆600 ml	术后发生肠梗阻，胃肠减压和对症处理	2 550	痊愈	8	正常
3	33	36	经产妇	重度子痫前期	产后出血	硫酸镁、拉贝洛尔、缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞6 U	术后血压升高，继续解痉、降压	1 900	痊愈	7	早产儿，轻度窒息，痊愈
4	28	37^＋4	经产妇	边缘性前置胎盘	胎盘粘连	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞3 U	常规处理	1 300	痊愈	7	正常
5	32	38^＋4	初产妇	巨大胎儿	产后出血	缩宫素、卡孕栓、卡前列素氨丁三醇	红细胞3 U	常规处理	1 500	痊愈	7	正常
6	35	37^＋3	经产妇	重度子痫前期、双胎妊娠	产后出血	硫酸镁、拉贝洛尔、缩宫素、卡前列素氨丁三醇	红细胞3 U、血浆300 ml	术后血压升高，继续解痉、降压	1 000	痊愈	7	正常
7	24	39	经产妇	双胎妊娠、瘢痕子宫	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞9 U、血浆700 ml、冷沉淀10 U	常规处理	3 000	痊愈	8	正常
8	32	33^＋2	经产妇	妊娠期高血压、瘢痕子宫、胎膜早破	正常位置胎盘部分植入	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞3 U、血浆300 ml	解痉、降压及对症处理	1 000	痊愈	8	早产儿，痊愈
9	27	39^＋2	经产妇	瘢痕子宫	胎盘粘连	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞8 U，血浆800 ml、冷沉淀10 U	常规处理	2 400	痊愈	8	正常
10	33	38^＋4	经产妇	瘢痕子宫、羊水过多	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞6 U，血浆600 ml	常规处理	2 000	痊愈	7	正常
11	35	39	经产妇	双胎妊娠	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞3 U	常规处理	1 500	痊愈	7	正常
12	32	39^＋1	初产妇	胎儿窘迫	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞6 U、血浆300 ml	常规处理	1 600	痊愈	7	正常

序号	年龄(岁)	孕周(周)	初/经产妇	术前诊断	并发症	治疗过程		术后处理	治疗效果		新生儿
序号	年龄(岁)	孕周(周)	初/经产妇	术前诊断	并发症	用药情况	输血情况	术后处理	出血量(ml)	术后42 d随访	术后住院时间(d)	结局
1	28	39^＋1	经产妇	瘢痕子宫	正常位置胎盘部分植入	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞12 U、血浆1 000 ml、冷沉淀10 U	术后腹腔引流血液1 200 ml，经纠正贫血及补充凝血因子，出血停止	3 000	痊愈	12	正常
2	26	38^＋6	初产妇	体外受精妊娠、胎膜早破	胎盘粘连	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞7.5 U、血浆600 ml	术后发生肠梗阻，胃肠减压和对症处理	2 550	痊愈	8	正常
3	33	36	经产妇	重度子痫前期	产后出血	硫酸镁、拉贝洛尔、缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞6 U	术后血压升高，继续解痉、降压	1 900	痊愈	7	早产儿，轻度窒息，痊愈
4	28	37^＋4	经产妇	边缘性前置胎盘	胎盘粘连	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞3 U	常规处理	1 300	痊愈	7	正常
5	32	38^＋4	初产妇	巨大胎儿	产后出血	缩宫素、卡孕栓、卡前列素氨丁三醇	红细胞3 U	常规处理	1 500	痊愈	7	正常
6	35	37^＋3	经产妇	重度子痫前期、双胎妊娠	产后出血	硫酸镁、拉贝洛尔、缩宫素、卡前列素氨丁三醇	红细胞3 U、血浆300 ml	术后血压升高，继续解痉、降压	1 000	痊愈	7	正常
7	24	39	经产妇	双胎妊娠、瘢痕子宫	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞9 U、血浆700 ml、冷沉淀10 U	常规处理	3 000	痊愈	8	正常
8	32	33^＋2	经产妇	妊娠期高血压、瘢痕子宫、胎膜早破	正常位置胎盘部分植入	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞3 U、血浆300 ml	解痉、降压及对症处理	1 000	痊愈	8	早产儿，痊愈
9	27	39^＋2	经产妇	瘢痕子宫	胎盘粘连	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞8 U，血浆800 ml、冷沉淀10 U	常规处理	2 400	痊愈	8	正常
10	33	38^＋4	经产妇	瘢痕子宫、羊水过多	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞6 U，血浆600 ml	常规处理	2 000	痊愈	7	正常
11	35	39	经产妇	双胎妊娠	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞3 U	常规处理	1 500	痊愈	7	正常
12	32	39^＋1	初产妇	胎儿窘迫	产后出血	缩宫素、卡前列素氨丁三醇、卡贝缩宫素	红细胞6 U、血浆300 ml	常规处理	1 600	痊愈	7	正常

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