Clinical effects of ergometrine maleate combined with oxytocin in prevention of postpartum hemorrhage of placenta previa puerperae after cesarean section

doi:10.3877/cma.j.issn.1673-5250.2019.04.016

Objective

To investigate the clinical effects of ergometrine maleate combined with oxytocin in prevention of postpartum hemorrhage (PPH) of placenta previa puerperae after cesarean section.

Methods

A total of 105 cases of puerperae who underwent cesarean section for placenta previa in Chengdu Women′s and Children′s Central Hospital from October 2016 to October 2018 were enrolled as research subjects. They were divided into group A (n=35), group B (n=35), and group C (n=35) according to the different methods of PPH prevention after cesarean section by retrospective method. Puerperae of group A were treated with ergometrine maleate combined with oxytocin, puerperae of group B were treated with oxytocin, and puerperae of group C were treated with ergometrine maleate for prevention of PPH after cesarean section. The volume of PPH, hemostasis time, uterine contraction and adverse reactions after cesarean section of three groups were observed. One-way ANOVA was conducted to compare the volume of PPH and hemostasis time after cesarean section among three groups, and least-significant difference (LSD) method was used for further comparison between each two groups. The rate of good uterine contraction and incidence of adverse reactions in three groups were compared by chi-square test, and adjustment of the test level method (α′=0.017) was used for further comparison. This study was in line the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Results

①There were no statistically significant differences among three groups in maternal age, gestational age, neonatal birth weight and constituent ratio of primipara and multipara (P>0.05). ②There were statistically significant differences among three groups in volumes of PPH during 0-2 h, 2-12 h, and 12-24 h after cesarean section, respectively (F=22.789, 24.826, 20.083, all P<0.001). Further comparison between each two groups showed that the volumes of PPH during 0-2 h, 2-12 h and 12-24 h after cesarean section in group A were significantly lower than those in group B and group C, and all the differences were statistically significant (group B vs group A: LSD-t=18.932, 29.863, 24.653, all P<0.001; group C vs group A: LSD-t=27.630, 32.973, 23.872, all P<0.001). ③The overall hemostasis time after cesarean section of three groups was statistically significant (F=27.987, P<0.001). Further comparison between each two groups showed that hemostasis time of group A was significantly shorter than those of group B and group C, and both the differences were statistically significant (LSD-t=28.631, 30.287, P<0.001). ④The rates of good uterine contraction during 0-2 h and 2-12 h after cesarean section in three groups were statistically significant (χ²=7.595, P=0.022; χ²=11.167, P=0.004). Further comparison between each two groups showed that the rates of good uterus contraction of group A during 0-2 h and 2-12 h after cesarean section were significantly higher than those of group C, and the rate of good uterus contraction during 2-12 h after cesarean section was significantly higher than that of group B (χ²=6.629, P=0.010; χ²=6.873, P=0.009; χ²=9.401, P=0.002). ⑤The incidences of total adverse reactions of group A, B and C were 17.1% (6/35), 45.7% (16/35), and 42.9% (15/35), respectively, and the difference was statistically significant (χ²=7.595, P=0.022). Compared with group B, the incidence of adverse reactions in group A was significantly lower, and the difference was statistically significant (χ²=6.629, P=0.010).

Conclusions

The administration of ergometrine maleate combined with oxytocin in placenta previa puerperae after cesarean section has the effects of preventing PPH. At the same time, it also has the effects of improving postoperative hemostasis, and reducing the incidence of adverse reactions. Ergometrine maleate combined with oxytocin has important clinical significances for preventing PPH of placenta previa puerperae after cesarean section.

Key words: Ergometrine maleate, Oxytocin, Placenta previa, Cesarean section, Postpartum hemorrhage, Puerperae

表1 3组前置胎盘产妇及其分娩新生儿一般资料比较

组别	例数	年龄(岁，±s)	孕龄(周，±s)	新生儿出生体重(g，±s)	产妇类型[例数(%)]
组别	例数	年龄(岁，±s)	孕龄(周，±s)	新生儿出生体重(g，±s)	初产妇	经产妇
A组	35	25.3±1.5	38.5±1.7	3 490±832	30(85.7)	5(14.3)
B组	35	25.8±1.5	38.5±1.8	3 617±874	28(80.0)	7(20.0)
C组	35	24.9±1.4	37.8±1.7	3 742±685	29(82.9)	6(17.1)
检验值	?	F＝0.564	F＝0.976	F＝0.910	χ²＝0.402
P值	?	0.972	0.766	0.750	0.818

表1 3组前置胎盘产妇及其分娩新生儿一般资料比较

组别	例数	年龄(岁，±s)	孕龄(周，±s)	新生儿出生体重(g，±s)	产妇类型[例数(%)]
组别	例数	年龄(岁，±s)	孕龄(周，±s)	新生儿出生体重(g，±s)	初产妇	经产妇
A组	35	25.3±1.5	38.5±1.7	3 490±832	30(85.7)	5(14.3)
B组	35	25.8±1.5	38.5±1.8	3 617±874	28(80.0)	7(20.0)
C组	35	24.9±1.4	37.8±1.7	3 742±685	29(82.9)	6(17.1)
检验值	?	F＝0.564	F＝0.976	F＝0.910	χ²＝0.402
P值	?	0.972	0.766	0.750	0.818

表2 3组前置胎盘产妇剖宫产术后不同时间段的PPH量总体及两两比较(mL，±s)

组别		例数	术后0～2 h	术后2～12 h	术后12～24 h
A组		35	124.5±5.5	83.8±3.2	64.2±4.1
B组		35	260.8±8.3	172.8±8.3	141.4±7.2
C组		35	271.2±9.4	180.7±8.3	140.7±7.2
总体比较		?	?	?	?
?	F值	?	22.789	24.826	20.083
?	P值	?	<0.001	<0.001	<0.001
A组vs B组		?	?	?	?
?	LSD-t值	?	18.932	29.863	24.653
?	P值	?	<0.001	<0.001	<0.001
A组vs C组		?	?	?	?
?	LSD-t值	?	27.630	32.973	23.872
?	P值	?	<0.001	<0.001	<0.001
B组vs C组		?	?	?	?
?	LSD-t值	?	0.923	0.736	0.027
?	P值	?	0.087	0.106	0.772

表2 3组前置胎盘产妇剖宫产术后不同时间段的PPH量总体及两两比较(mL，±s)

组别		例数	术后0～2 h	术后2～12 h	术后12～24 h
A组		35	124.5±5.5	83.8±3.2	64.2±4.1
B组		35	260.8±8.3	172.8±8.3	141.4±7.2
C组		35	271.2±9.4	180.7±8.3	140.7±7.2
总体比较		?	?	?	?
?	F值	?	22.789	24.826	20.083
?	P值	?	<0.001	<0.001	<0.001
A组vs B组		?	?	?	?
?	LSD-t值	?	18.932	29.863	24.653
?	P值	?	<0.001	<0.001	<0.001
A组vs C组		?	?	?	?
?	LSD-t值	?	27.630	32.973	23.872
?	P值	?	<0.001	<0.001	<0.001
B组vs C组		?	?	?	?
?	LSD-t值	?	0.923	0.736	0.027
?	P值	?	0.087	0.106	0.772

表3 3组前置胎盘产妇剖宫产术后止血时间总体及两两比较(min，±s)

组别		例数	术后止血时间
A组		35	42.9±3.8
B组		35	69.8±3.6
C组		35	70.1±3.5
总体比较		?	?
?	F值	?	27.987
?	P值	?	<0.001
A组vs B组		?	?
?	LSD-t值	?	28.631
?	P值	?	<0.001
A组vs C组		?	?
?	LSD-t值	?	30.287
?	P值	?	<0.001
B组vs C组		?	?
?	LSD-t值	?	0.872
?	P值	?	0.100

表3 3组前置胎盘产妇剖宫产术后止血时间总体及两两比较(min，±s)

组别		例数	术后止血时间
A组		35	42.9±3.8
B组		35	69.8±3.6
C组		35	70.1±3.5
总体比较		?	?
?	F值	?	27.987
?	P值	?	<0.001
A组vs B组		?	?
?	LSD-t值	?	28.631
?	P值	?	<0.001
A组vs C组		?	?
?	LSD-t值	?	30.287
?	P值	?	<0.001
B组vs C组		?	?
?	LSD-t值	?	0.872
?	P值	?	0.100

表4 3组前置胎盘产妇剖宫产术后不同时间段的子宫收缩良好率总体及两两比较[例数(%)]

组别		例数	术后0～2 h	术后2～12 h	术后12～24 h
A组		35	29(82.9)	32(91.4)	33(94.3)
B组		35	20(57.1)	21(60.0)	32(91.4)
C组		35	19(54.3)	23(65.7)	33(94.3)
总体比较		?	?	?	?
?	χ²值	?	7.595	11.167	0.306
?	P值	?	0.022	0.004	0.858
A组vs B组		?	?	?	?
?	χ²值	?	5.510	9.401	—
?	P值	?	0.019	0.002	—
A组vs C组		?	?	?	?
?	χ²值	?	6.629	6.873	—
?	P值	?	0.010	0.009	—
B组vs C组		?	?	?	?
?	χ²值	?	0.058	0.245	—
?	P值	?	0.810	0.621	—

表4 3组前置胎盘产妇剖宫产术后不同时间段的子宫收缩良好率总体及两两比较[例数(%)]

组别		例数	术后0～2 h	术后2～12 h	术后12～24 h
A组		35	29(82.9)	32(91.4)	33(94.3)
B组		35	20(57.1)	21(60.0)	32(91.4)
C组		35	19(54.3)	23(65.7)	33(94.3)
总体比较		?	?	?	?
?	χ²值	?	7.595	11.167	0.306
?	P值	?	0.022	0.004	0.858
A组vs B组		?	?	?	?
?	χ²值	?	5.510	9.401	—
?	P值	?	0.019	0.002	—
A组vs C组		?	?	?	?
?	χ²值	?	6.629	6.873	—
?	P值	?	0.010	0.009	—
B组vs C组		?	?	?	?
?	χ²值	?	0.058	0.245	—
?	P值	?	0.810	0.621	—

表5 3组前置胎盘产妇剖宫产术后不良反应率总体及两两比较[例数(%)]

组别		例数	恶心呕吐	心率增快	血压升高	胸闷憋气	合计
A组		35	1(2.9)	2(5.7)	2(5.7)	1(2.9)	6(17.1)
B组		35	4(11.4)	5(14.3)	3(7.3)	4(11.4)	16(45.7)
C组		35	2(5.7)	4(11.4)	5(14.3)	4(11.4)	15(42.9)
总体比较		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	7.595
?	P值	?	—	—	—	—	0.022
A组vs B组		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	6.629
?	P值	?	—	—	—	—	0.010
A组vs C组		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	5.510
?	P值	?	—	—	—	—	0.019
B组vs C组		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	0.058
?	P值	?	—	—	—	—	0.810

表5 3组前置胎盘产妇剖宫产术后不良反应率总体及两两比较[例数(%)]

组别		例数	恶心呕吐	心率增快	血压升高	胸闷憋气	合计
A组		35	1(2.9)	2(5.7)	2(5.7)	1(2.9)	6(17.1)
B组		35	4(11.4)	5(14.3)	3(7.3)	4(11.4)	16(45.7)
C组		35	2(5.7)	4(11.4)	5(14.3)	4(11.4)	15(42.9)
总体比较		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	7.595
?	P值	?	—	—	—	—	0.022
A组vs B组		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	6.629
?	P值	?	—	—	—	—	0.010
A组vs C组		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	5.510
?	P值	?	—	—	—	—	0.019
B组vs C组		?	?	?	?	?	?
?	χ²值	?	—	—	—	—	0.058
?	P值	?	—	—	—	—	0.810

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