The Clinical Value Of The Risk Evaluation System Of Postpartum Hemorrhage And The Study Of Different Uterotonic

ObjectiveTo explore the feasibility and value of the clinical practice of the risk evaluation system of postpartum hemorrhage(PPH); and to compare the effects of the oxytocin and Hemabate on the contractions freguency and amplitude of myometrial strips isolated from term-pregnant rats, and provide reference for clinical rational use.Methods802pregnant women who presented to Fuqing Maternity and Child Health Hospital for parturition in August were chosen to apply this system.By which we predicted the risk score in pregnancy and term; in order to reduce the incidence of PPH, we actively treated risk factors; statistics on the incidence of postpartum hemorrhage; and use the prediction equation to predict the probability of occurrence in PPH; at the same time, a retrospective study was conducted with the802maternals by using the "predice-scale of PPH" which was set by national PPH Prevention cooperatio; compare effectiveness between them by receiver-operating characteristics.Dividing the myometrial strips which were isolated from term-pregnant rats and kept in uterine muscle keeper solution into blank control group, oxytocin group, and Hemabate grop randomly, using the tension transducer and RM6240biological signal acquisition system to determine the changes of the contractions frequency and amplitude of them.Results1. By using the system, the incidence of PPH was4.99%, lower than the same month last yea, which didn’t use(P<0.05), and the sever PPH rate、blood products utilization rate are reduced(P<0.05).2. Using the system, the score0-3sub-division in prenatal point is lower than the average rate(P<0.01), and the score>4sub-division was significantly higher than the average rate(P<0.01); the overall score0-5sub-division is lower than the average rate(P<0.01), and the score≥6sub-division was significantly higher than the average rate(P<0.01); The PPH was significantly and positively correlated with the score prediction table(r1=0.939, P1=0.002; r2=0.865, P2=0.001).3. Application of the risk evaluation system of PPH showed that the higher of the predict score is, the more amount of bleeding and the higher incidence of PPH is.4. AUC of predict-scale used in this study was0.733(prenatal scores) and0.851(total scores), simultaneity, AUC of risk evaluation system was0.839(prenatal scores) and0.922(total scores).5. In this study, we used multivariate correlation analysis to show that placental adherence or accrete、genital tract trauma、third stage prolonged、first stage abnormal were more closely related with PPH.6. The frequency, amplitude and activity of myometrial contractility in oxytocin group and Hemabate group were higher than in blank control group(P<0.05).7. The frequency, amplitude and activity of myometrial contractility in oxytocin group were lower than in Hemabate group(P<0.05).8. Giving oxytocin consistently in oxytocin group until the contractions of myometrial strips no stronger any more, while giving Hemabate can make the contraction potentiality increased(P<0.05).Conclusions1. The risk evaluation system of Postpartum hemorrhage is high sensitivity and specificity as to detection of postpartum hemorrhage(PPH). Application of the risk evaluation and prediction equation for the risk of morbidity is helpful to improve the accuracy of the prediction of PPH and to reduce the incidence of PPH and complications.2. The risk evaluation system was more efficient than the predict-scale for detecting PPH.3. The risk evaluation system of Postpartum hemorrhage is a simple, functional and effective method to screen postpartum hemorrhage(PPH). Application of this system to screen high risk group in clinical and treatment high risk factor activity to low the score can reduce postpartum hemorrhage. As its effectiviy, we should spread the system.4. The frequency, amplitude and activity of myometrial contractility in Hemabate group were significantly higher than in oxytocin group. So Hemabate is better than oxytocin in increasing uterine smooth muscle contraction, rational clinical use can promote uterine contraction, and reduce bleeding.5. Giving oxytocin consistently in oxytocin group until the contractions of myometrial strips no stronger any more, while giving Hemabate can make the contraction potentiality increased.Which mean that Hemabate may be effective to uterine contractions fatigue postpartum hemorrhage while common therapeutic measures ineffective. In order to effectively reduce postpartum blood loss and the occurrence of postpartum hemorrhage, we should grasp the opportunity of using Hemabate.