摘要
目的:分析产后出血的危险因素,探讨产后出血的防治措施。
方法:对齐鲁医院1999~2003年共148例产后出血病例(研究组)进行回顾性分析,对产妇的年龄、体重指数、孕周、孕产次、流产次数、胎儿数、分娩方式、产程、胎儿体重、产后出血量、产后出血发生时间、出血原因、治疗措施及转归等多项指标进行观察;同时以2∶1的比例随机选取同期非产后出血孕妇296例作为对照组,通过多因素Logistic回归分析筛选出与产后出血相关的主要危险因素。还分析总结了产后出血的处理方法。
结果:5年的纠正产后出血率为1.38%(137/9925)。2002年和其他各年间产后出血率有极显著性差异(P<0.01),其他各年间无显著性差异(P>0.05)。发生在产后2h内者128例,占86.49%。宫缩乏力108例,占72.97%。胎盘因素17例,占11.49%。凝血功能异常12例,占8.11%。软产道裂伤11例,占7.43%。发生失血性休克14例,其中外院转入7例。行双侧子宫动脉结扎术1例,双侧髂内动脉结扎术1例,双侧子宫动脉结扎加双侧髂内动脉结扎术1例,子宫切除术3例,死亡2例。对产后出血的高危因素进行单因素分析,有17个因素有统计学意义;多因素Logistic回归分析显示对产后出血影响最大的依次为前置胎盘(OR=20.459)、宫缩乏力(OR=17.533)、软产道裂伤(OR=16.235)、胎盘因素(OR=14.842)、胎儿体重≥4000g(OR=13.056)、第三产程≥10min(OR=6.930)、剖宫产(OR=3.041)、子痫前期(OR=2.786)及早接触早吸吮(OR=0.081)。
结论:产后出血是产科的严重并发症之一。宫缩乏力是引起产后出血的首要因素,减少巨大儿和多胎妊娠的发生对减少产后出血具有重要意义。胎盘因素是引起产后出血的第二病因,是导致产科子宫切除的首要原因。加强计划生育宣教,减少产前的非意愿性妊娠及流产而致的子宫内膜损伤,提倡少生优生,可减少胎盘因素所致产后出血的发生。加强产前、产时及产后对产后出血的预防;严格掌握剖宫产指征,降低剖宫产率;提高手术技巧,避免意外损伤,是减少产后
Objective: To investigate the risk factors of postpartum hemorrhage (PPH) and to explore the better methods of prevention and treatment.
Methods: Clinical data of 148 cases of PPH (research group) hospitalized from 1999 to 2003 in QiLu hospital were retrospectively analyzed. The following items were investigated : age、body mass index、 gestational weeks、etiological factors> volume of blood loss、abortion history、the number of parturition and fetus、fetus weight、delivery manner、prevention and treatment; We also collected the other 296 non-PPH cases over the 5 years randomly as control group, high risk factors were analyzed using logistic regression by SPSS statistical software. The treatment methods of postpartum hemorrhage in our hospital were also summarized.
Results: The corrective PPH rate over the 5 years is 1.38%(137/9925). The PPH rate of 2002 was significantly lower than the other years, and no difference between the other years. 128 cases happened in 2 hrs after delivery(86.49%).The primary cause was uterine inertia (72.97%), and the second was placenta factor(11. 49%), the third was blood coagulation disorder (8.11%), the last was soft birth canal injury (7. 43%). There were 14 cases hemorrhagic shock, of which 7 cases were transmitted from the other hospitals. In all 148 patients, bilateral uterine artery ligation was performed in 1 case, bilateral hypogastric artery ligation in 1 case, uterine and hypogastric artery ligation in 1
引文
1.段涛,丰有吉,狄文主译.威廉姆斯产科学.第21版.济南:山东科学技术出版社,2006,561
2.WHO, UNICEF, UNFPA. Maternal Mortality in 2000. 2004
3.全国孕产妇死亡监测协作组.全国孕产妇死亡监测结果分析.中华妇产科杂志,1999,34(11):645-648
4.刘俊兰,侯海燕,陈志新,等.山东省孕产妇死亡监测产科出血死亡177例分析.中国误诊学杂志,2002,(2)3:361-363
5.乐杰主编.妇产科学.第六版.北京:人民卫生出版社,2004,224-227
6. Pritchard JA. Changes in the blood volume during pregnancy and delivery. Anesthesiology, 1965, 26: 293
7.南京市围产期保健协作组.1999年南京市剖宫产术产后出血情况分析.中华妇产科杂志,2001,36:731-733
8.冯洁,戴钟英,吴氢凯,等.阴道分娩产后出血量的精确测定与血液指标的关系研究.实用妇产科杂志,2003,19(5):281-283
9.美国家庭医师学会编.高级产科生命支持.第4版.北京:中国协和医科大学出版社,2002,177
10.全国产后出血防治协作组.中国妇女产时及产后24小时内失血量调查.中华妇产科杂志,1987,22:316-319
11. Hendricks MS, Chow YH, Bhagavath B, et al. Previous cesarean section and abortion as risk factor for developing placenta previa. J Obstet Gynaecol Res, 1999, 25(2): 137-142
12. Ceminski A, Dlugolecki F. Relationship between placenta previa and maternal age, parity and casarean deliveries. Ginekol Pol, 2005, 76(4): 284-289
13. Zelop CM, Harlow BL, Frigeletto FD, et al. Emergency peripartum hysterectomy, Am J Obstet Gynecol, 1993, 168: 1443
14.刘志蓉.产科子宫切除28例临床分析.实用妇产科杂志,2002,18(1):53-54
15.李梅,张咏梅,赵春艳,等.初产妇与经产妇巨大儿分娩方式比较.中国妇产 科临床杂志,2004,(5)6:423-424
16. Wallker MC, Murphy KE, Pan S, et al. Adverse maternal outcomes in multifetal pregnancy. BJOG, 2004, 111(11): 1294-1296
17. Liu S, Heaman M, Joseph gS, et al. Risk of maternal postpartum readimission associated with mode of delivery. Obstet Gynecol, 2005, 105(4): 836-842
18. Phillip H, Fletcher H, Reid M. The impact of induced labour on postpartum blood loss. J Obstet Gynaecol, 2004, 24(1): 12-15
19.汪丹,秦利.欣母沛治疗产后出血的临床研究.国外医学妇幼保健分册,2004,16(2):124-125
20. Ahonen J, Jokela R. Recombinant factor Ⅶa for life-threatening post-partum haemorrhage. Br J Anaesth, 2005, 94(5): 592-595
21. Hebisch G, Huch A. Vaginal uterine artery ligation avoids high blood loss and puerperal hysterectomy in postpartum hemorrhage. Obstet Gynecol, 2002, 100(3): 574-578
22. Papp Z, Toth-Pal E, Papp C, et al. Silateral hypogastric artery ligation for intractable pelvic hemorrhage. Int Gynecol Obstet, 2005, 92(1): 27-31
23. AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol, 1997, 171(6): 694-700
24. Wax Jr, Chawnell JC, Nandersloot JA. Packing of the lower uterine segment-new approach to an old technique. Int J Gynecol obstet, 1993, 43: 197-198
25.丁惠群,杨宾烈,林其德.改良B-Lynch缝线术处理宫缩乏力性产后出血4例报告.现代妇产科进展,2004,13(5):383-384
26. Pelage JP, Le Dref O, Mateo J, et al. Life-threatening primary postpartum hemorrhage: Treatment with emergency selective arterial embolization. Radiology, 1998, 208: 359-362
27. Ornan D, White R, Pollak J Tal M. Pelvic embolization for intractable postpartum hemorrhage: long-term follow-up and implications for fertility. Obstet Gynecol, 2003, 102(5 Pt 1): 904-910
28. Zorlu CG, Turan C, Lsik AZ, et al. Emergency hysterectomy in moderm obstetric practice. Changing clinical perspective in time. Acta Obstet Gynecol Scand, 1998, 77(2): 186-190
1. WHO, UNICEF, UNFPA. Maternal Mortality in 2000. 2004
2.全国孕产妇死亡监测协作组.全国孕产妇死亡监测结果分析.中华妇产科杂志,1999,34(11):645-648
3.刘俊兰,侯海燕,陈志新,等.山东省孕产妇死亡监测产科出血死亡177例分析.中国误诊学杂志,2002,(2)3:361-363
4.段涛,丰有吉,狄文主译.威廉姆斯产科学.第21版.济南:山东科学技术出版社,2006,561
5.全国产后出血防治协作组.中国妇女产时及产后24小时内失血量调查.中华妇产科杂志,1987,22:316-319
6.乐杰主编.妇产科学.第六版.北京:人民卫生出版社,2004,224-227
7. Pritchard JA. Changes in the blood volume during pregnancy and delivery. Anesthesiology, 1965, 26: 293
8. Combs CA, Murphy EL, Laros RK. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol, 1991, 77: 69-72
9. Pritchard JA, Baldwin RM, Dickey JC, et al. Blood volume changes in pregnancy and the puerperiu. Ⅱ. Red blood cell loss and changes in apparent blood volume during and following vaginal delivery. cesarean section and cesarean section plus hysterectomy. Am J Obstet Gynecol, 1962, 84: 1271-1282
10.上海产后出血研究协作组.上海市5365例阴道分娩产后出血计量研究.上海医学,2001,24(6):327-331
11.南京市围产期保健协作组.1999年南京市剖宫产术产后出血情况分析.中华妇产科杂志,2001,36:731-733
12.冯洁,戴钟英,吴氢凯,等.阴道分娩产后出血量的精确测定与血液指标的关系研究.实用妇产科杂志,2003,19(5):281-283
13.美国家庭医师学会编.高级产科生命支持.第4版.北京:中国协和医科大学出版社,2002,177
14. O'Leary JL, O'Leary JA. Uterine artery in the control of intractable postpartum hemorrhage. Am J Obstet Gynecol, 1966, 94(7): 920-924
15.黄瑾,顾美皎,方玲,等.难治性产后出血干预性治疗方法的对比研究.中国实用妇科与产科杂志,2004,20(6):343-345
16.林建华,林其德,刘建华,等.产后出血的重新评估.中国实用妇科与产科杂志,2002,18(2):89-91
17.林建华.如何正确估计剖宫产的产后出血量.实用妇产科杂志,2003,19(5):260
18.吴氢凯,罗来敏,戴钟英.用称重法精确测量产后出血量的临床研究.实用妇产科杂志,1998,14(3):144-145
19. Watson P. Postpartum hemorrhage and shock. Clin Obstet Gynecol, 1980, 23(4): 985-1001
20.沈巧珍.产后出血测量法的研究.中华妇产科杂志,1988,(23)6:370
21.申玉红.如何正确估计阴道分娩的产后出血量.实用妇产科杂志,2003,19(5):259-260
22.谷进,刘穗玲,陶欣,等.产妇精神因素对分娩方式及产后出血的影响.中国实用妇科与产科杂志,1999,15(10):615-616
23. Mazor M, Hershkovitz R, Bashiri A, et al. Meconium stained amniotic fluid in preterm delivery is an independent risk factor perinatal complications. Eur J obstet Gynecol Reprod Biol, 1998, 81(1): 9-13
24. Dai D, Kumat NS, Wolf DM, et al. Molecular tools to reestablish progestin control of endometrial cancer cell proliferation. Am J Obstet Gynecol, 2001, 184: 790-797
25. Hayashi M, Mori Y, Nogami K, et al. A hypothesis to explain the occurence of inner myometrial laceration causing massive postpartum hemorrhage. Acta Obstet Gynecol Scand, 2000, 79(2): 99-106
26. Baskett TF. Acute uterine inversion: a review of 40 cases, J Obstet Gvnaecol Can. 2002. 24(12): 953-956
27.苏应宽主编.实用产科学.第二版.济南:山东科学技术出版社,2004,483
28.曹泽毅主编.中华妇产科学.第二版(上册).北京:人民卫生出版社,1999, 823-824
29.方秀岑,吕惠玲,潘凤兰,等.子宫内翻致产妇死亡分析.中国妇幼保健,1993,8(3):39
30. Hendricks CH, Brenner WE. Cardiovascular effects of oxytocic drugs used postpartum. Am J Obstet Gynecol, 1970, 108: 751
31. Secher NJ, Arnsbo P, Wallin L. Haemodynamic effects of oxytocin (syntocinon) and methyl ergometrine (methergin) on the systemic and pulmonary circulations of pregnant anaesthetized women. Acta Obstet Gynecol Scand. 1978, 57(2): 97-103
32.陈新谦主编.新编药物学.第14版.北京:人民卫生出版社.1998,382
33.杨梦庚.子宫收缩乏力性产后出血的防治.中国实用妇科与产科杂志,1993,9(4):199
34. Morey SS. ACOG releases report on risk factor, causes and management of postpartum hemorrage. Am Famil Physician, 1998, 58(11): 1002-1004
35.张惜阴主编.实用妇产科学.北京:人民卫生出版社,2003,454-459
36. Kupferminc MJ, Gull I, Bar-Am A. Intrauterine irrigation with prostaglandin F2-alpha for management of severe postpartum hemorrhage Acta Obstet Gynecol Scand, 1998, 77(5): 548-550
37. Oleen MA, Mariano JP. Controling refractory atonic postpartum hemorrhage with Hemabate sterile solution. Am J Obstet Gynecol, 1990, 162: 205
38.汪丹,秦利.欣母沛治疗产后出血的临床研究.国外医学妇幼保健分册,2004,16(2):124-125
39.吴正英.子宫下段置入卡孕栓治疗剖宫产术中出血40例.医学理论与实践,2003,16(6):68
40.赵日孝,厉宣英,彭艳,等.米索前列醇预防剖宫产术后出血的临床研究.中华妇产科杂志,1998,33(7):403-405
41. Zachariah ES, Naidu M, Seshadri. Oral misoprostol in the third stage of labor, lnt J Gynaecol Obstet, 2006, 92(1): 23-26
42. Abdel-Aleem H, El-Nashar I, Abdel-Aleem A. Management of severe postpartum hemorrhage with misoprostol. Int J Gynaecol Obstet, 2001, 72(1): 75-76
43. O'Brain P, EL-Refaey H, Gordon A, et al. Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study. Obstetric and Gynecology, 1998, 92 (2): 212-214
44. Mathlouthi N, Khemiri B, Chennoufi MB, et al. Sulprostone in the treatment of uterine inertia. Report of 60 cases. Tunis Med, 2004, 82(10): 958-963
45. Bayoumeu F, Aallali M, Koebele A, et al. Chest pain and sulpostone during postpartum hemorrhage. Ann Fr Anesth Reanim, 2002, 21(8): 668-671
46. Chen FG, Koh KF, Chong YS. Cardiac arrest associated with sulprostone use during caesarean section. Anaesth Intensive Care, 1998, 26(3): 298-301
47.苟学萍,程琼,曹坪.前列腺素E1治疗宫缩乏力性产后出血30例临床分析.第三军医大学学报,2003,25(24):2231
48.高树生,蔡德修,王卫疆,等.应用10%葡萄糖酸钙辅助治疗宫缩乏力性产后出血.现代妇产科进展,2000,9(1):61
49.许建娟.钙剂在难治性产后出血中的应用.中国优生与遗传杂志,1997,5(6):63-64
50.陈明,孙兴梅.肾上腺素液宫腔灌注治疗产后出血22例疗效分析.吉林大学学报(医学版),2004(2):217
51. Holub Z, Feyereisl J, Kabelik L, Rittstein T. Successful treatment of severe post-partum bleeding after caesarean section using recombinant activated factor Ⅶ. Ceska Gynekol, 2005, 70(2): 144-146
52. Ahonen J, Jokela R. Recombinant factor Ⅶa for life-threatening post-partum haemorrhage. Br J Anaesth, 2005, 94(5): 592-595
53. Wittich Ac, Salminen ER, Hardin El, et al. Uterine packing in the combined management of obstetrical hemorrhage. Mil Med, 1996, 161(3): 180-182
54. Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol, 1993, 169(2 Pt1): 317-321
55. Bobrowski RA, Jones TB. A thrombogenic uterine pack for postpartum hemorrhage. Obstet Gynecol, 1995, 85(5 Pt 2): 836-837
56. Haq G, Tayyab S. Control of postpartum and post abortal haemorrhage with uterine packing. J Pak Med Assoc, 2005, 55(9): 369-371
57.郑玉华,林育娇,郭晓玲.宫腔填塞凝血酶纱条治疗难治性产后出血.广东医学,2005,26(7):966-967
58. Akhter S, Begum MR, Kabir Z, et al. Use of a condom to control massive postpartum hemorrhage. MedGenMed, 2003, 5(3): 38
59. Seror J, Allouche C, Elhaik S. Use of Sengstaken-Blakemore tube in massive postpartum hemorrhage: a series of 17 cases. Acta Obstet Gynecol Scand, 2005, 84(7): 660-664
60. Ferrazzani S, Guariglia L, Caruso A. Therapy and prevention of obstetric hemorrhage by tamponade using a balloon catheter. Minerva Ginecol, 2004, 56(5): 481-484
61.戴钟英.髂内动脉结扎术在妇产科的应用.中华妇产科杂志,1991,26(1):52
62. Palacios Jarquemada JM. Surgical training in selective pelvic arterial ligation or use of embolization only. Am J Obstet Gynecol, 2000, 182(1Pt1): 252
63. O'Leary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med, 1995, 40(3):189-193
64.李家福,胡珈瑞,罗新,等.结扎子宫动脉上行支对剖宫产术出血的防治.中国实用妇科与产科杂志,2003,19(7)415-416
65. Hebisch G, Huch A. Vaginal uterine artery ligation avoids high blood loss and puerperal hysterectomy in postpartum hemorrhage. Obstet Gynecol, 2002, 100(3): 574-578
66. Phillippe HJ, d'Oreye D. Vaginal ligature of uterine arteries during postpartum hemorrhage. Int J Gynecol Obstet, 1997, 56(3): 267-270
67.江森,殷立基,孙树三.关于子宫颈癌根治术式及主要并发症预防的探讨.中华妇产科杂志,1980,15(4):231
68. Burchell RC. Physiology of internal iliac artery ligation. J Obstet Gynaecol Br Commonw, 1968, 75(6): 642-651
69. Casele HL, Laifer SA. Successful pregnancy after bilateral hypogastric artery ligation. A case report. J Reprod Med, 1997, 42(5): 306-308
70. Fehrman H. Surgical management of life threatening obstetric and gynecologic hemorrhage. Acta Obstet Gynecol Scand, 1988, 67(1): 125
71.郝敏,王志莲.髂内动脉结扎在晚期产后出血中的应用价值.中国实用妇科产科与杂志,2001,17(2):76-77
72. Papp Z, Toth-Pal E, Papp C, et al. Bilateral hypogastric artery ligation for intractable pelvic hemorrhage. Int Gynecol Obstet, 2005, 92(1): 27-31
73. AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol, 1997, 171(6): 694-700
74. Wax Jr, Chawnell JC, Nandersloot JA. Packing of the lower uterine segment-new approach to an old technique. Int J Gynecol obstet, 2003, 43: 197-198
75. B-Lynch C. The B-Lych surgical technique for the control of massive postpartum hemorrhage. Br J Obstet Gynecol, 1997, 104(3): 372-375
76. Wohlmuth CT, Gumbs J, Quebral-Ivie J. B-Lynch suture: a case series. Int J Fertil Womens Med, 2005, 50(4): 164-173
77. Api M, Api O, Yayla M. Fertility after B-Lynch suture and hypogastric artery ligation. Fertil Steril, 2005, 84(2): 509
78.丁惠群,杨宾烈,林其德.改良B-Lynch缝线术处理宫缩乏力性产后出血4例报告.现代妇产科进展,2004,13(5):383-384
79. Pelage JP, Laissy. Management of life-threatening postpartum hemorrhage: indications and technique of arterial embolization. J Gynecol Obstet Biol Repord(Paris), 2004, 33(8 Suppl): 4S93-4S102
80. Chin HG, Scott DR, Resnik R, et al. Angiographic embolization of intractable puerperal hematomas. Am J Obstet Gynecol, 1999, 160: 434-438
81. Pelage JP, Le Dref O, Mateo J, et al. Life-threatening primary postpartum hemorrhage: Treatment with emergency selective arterial embolization. Radiology, 1998, 208: 359-362
82. Boulleret C, Chahid T, Gallot D, et al. Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Intervent Radiol, 2004, 27(4): 344-348
83.陈春林,李小毛,李国梁,等.介入治疗在重度产后出血中的应用.中国实用妇科与产科杂志,2001,17(2):84-85
84. Ornan D, White R, Pollak J Tal M. Pelvic embolization for intractable postpartum hemorrhage: long-term follow-up and implications for fertility. Obstet Gynecol, 2003, 102(5 Pt 1): 904-910
85. Hansch E, Chitkara U, Mc Alpine J, et al. Pelvic arterial embolization for control of obstetic hemorrhage: a five-year experience. Am J Obstet Gynecol, 1999, 180(6): 183-187
86. Cottier Jp. Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet gynecol, 2002, 100: 1074
87. Mason BA. Postpartum hemorrhage and arterial embolization. Curr Opin Obstet Gynecol, 1998, 10: 475-479
88.马水清,边旭明,郎景和,等.产科临床中的子宫切除术.中国实用妇科与产科杂志,2000,15:39-40
89. Zorlu CG, Turan C, Lsik AZ, et al. Emergency hysterectomy in moderm obstetric practice. Changing clinical perspective in time. Acta Obstet Gynecol Scand, 1998, 77(2): 186-190
90. Kastner ES, Figueroa R, Garry D. Emergency peripartum hysterectomy: a commmunity teaching hospital. Obstet Gynecol, 2002, 99(6): 971-975
91. Forna F, Miles AM, Jamieson DJ. Emergency peripartum hysterectomy: a comparison of cesarean and postpartum hysterectomy. Am J Obstet Gynecol, 2004, 190(5): 1440-1444
92.朱坤仪,梁心玲,梁晓阳,等.急症子宫切除术在产科大出血中的应用及评价.中华妇产科杂志,2003,38(7):388-389
93.俞峥,鲁红.超声对胎盘植入的诊断价值.中华超声影像学杂志,2003,12(9):562-563
94. Lalchandani S, Geary M, O'Herlihy C, et al. Conservative management of placenta accreta and unruptured interstitial cornual pregnancy using methotrexate. Eur J Obstet Gynecol Reprod Biol, 2003, 107(1): 96-97
95.胡平,黄任.甲氨喋呤治疗胎盘植入12例报道.实用妇产科杂志,2004,20(6):345
96.马振芳,邢明晖,王德芬.米非司酮在植入性胎盘的应用.上海医学,2001(9):23
97.黄维新.植入性胎盘的保守治疗.中国实用妇科与产科杂志,1999,15(5):2711
98.朱关珍.植入性胎盘的保守治疗.中国实用妇科与产科杂志,1996,12(5):266
99. Courbiere B, Bretelle F, Porcu G, Gamerre M, Blanc B. Conservative treatment of placenta accreta J Gynecol Obstet Biol Reprod (Paris), 2003, 32(6): 549-554
100.陈韵仙,焦书竹.软产道损伤的诊断与处理.实用妇产科与产科杂志,1992,4(8):17
101.李小毛.剖宫产术中副损伤的预防与处理.中国实用妇科与产科杂志,2003,19(7):391
102.杨梦庚,严新宇,李希玲,等.实用妇科与产科杂志,1990,6(4):201-202
103.张颖,江涛,李英勇.子宫内翻17例分析.中国实用妇科与产科杂志.2004.20(12):755-756
104.王玉华.应用“产后出血预测评分表”预测评分减少产后出血.中国妇幼保健,2005,20(7):859-860
105.胡冰梅.高危因素评分法预测产后出血的临床研究.实用医学杂志,2002,18(6):643-644
106.王迦略,叶蓉华,杨孜,等.产后出血的高危因素分析.中国妇产科临床杂志,2003,4(4):266-267
107.顾玮,苏琦枫,黄咏梅.产后出血相关因素分析.中国实用妇科与产科杂志,2004,(20)11:677-678
108. Naef RW 3rd, Chauhan SP, Chevalier SP, et al. Prediction of hemorrhage at cesarean delivery. Obstet Gynecol, 1994, 83(6): 923-926
109. Sheiner E, Sarid L, Levy A. Obstetric risk factor and outcome of pregnancies complicated with early postpartum hemorrhage: A population-based study. J Matern Fetal neonatal Med, 2005, 18(3): 149-154
110.程蔚蔚,李笑天.高危评分法预测前置胎盘的产后出血.中华围产医学杂志,2004,7(5):262-263
111.蔡祥莺,何成章,冯佩珍,等.第三产程中胎盘剥离过程的动态超声观察.中华妇产科杂志,2003,(38)4:213-214
112. Magann EF, Evans S, Chauhan SP. The length of the third stage of labor and risk of postpartum hemorrhage. Obstet Gynecol, 2005, 105(2): 290-293
113. Prendiville WJ, Elbouene D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database Syst Rev. 2000; (2): CD000007
114.熊庆.产后出血的诊治与预防.中华妇产科杂志,1995,30(4):241.
115. McDonald SJ. Randomised controlled trial of oxytocin alone vs oxytocin and ergometrine in active management of third stage of labor. BMJ, 1993, 307(12): 1167
116.顾伯铭.预防产后出血的有效方法.中国实用妇产科杂志,1993,9(3):196
117. Soriano DA. Prospective cohort study of oxytocin plus gometrine compared with oxytocin alone for prevention of postpartum hemor rhage. Br J Obstet Gynecol, 1996, 103 (11): 1068
118. kundodyiwa TW, Majoko F, Rusakaniko S. Misoprostol versus oxytocin in the third stage of labor. Int J Gyneco Obstet, 2001, 75(3): 235-241
119.施鑫锋.米索前列醇对妊高征患者产后出血的影响.实用妇产科杂志,2002,18(2):118-119
120.李强.米索前列醇预防妊高征剖宫产术后出血的临床研究.中国计划生育杂志,2004,6:355-357
121.刘彩霞,王德智,杨玉侠,等.卡孕栓预防产后出血230例临床分析.中国实用妇科与产科杂志,1995,11(5):291-292
122.刘彩霞.刺激乳头对产后出血的影响.中国实用妇产科杂志,1993,9(4):213
123. Kim YM, TejaniN, Chayen B, et al. Management of the third stage of labor with nipple stimulation. J Reprod Med, 1986, 31: 1033
124.熊小娟,周惠珍,王小兰,等.乳房按摩对第三产程及产后出血的影响.中华妇产科杂志,1996,31(2):117-118