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产后大出血

大多数国家的指引建议在第三阶段预防性应用催产素,同时推荐所有高风险分娩中使用。可选择的催产素有:子宫收缩药麦角新碱,米索前列醇 和卡贝缩官素。 每个选择之间的剂量相差很大。

Available guidelines

 

Region Country Date Source url Active treatment of 3rd stage labour PPH prophylaxis
Europe Austria 2011 n/a • Oxytocin and carbetocin Vaginal deliveries
1. Oxytocin (3–5 IU IV)
Europe Czech Republic 2011 Link 1. Oxytocin, carbetocin or methylergometrine Caesarean sections
1. Oxytocin or carbetocin
2. Controlled cord traction
3. Cord clamping and cutting
Europe Denmark 2013 n/a 1. Syntocinon (40–80 IU diluted and administered via infusion pump at a rate of 180 mL/hour)
2. Cytotec (0.4 mg sublingual/rectal)
3. Methylergometrine (0.2 mg IM)
4. Carboprost (Prostinfenem; 0.25 mg/mL IM)
5. Carbetocin (100 mcg slow IV)

 

Vaginal and caesarean deliveries
1. Syntocinon (40–80 IU diluted and administered via infusion pump at a rate of 180 mL/hour)
2. Cytotec (0.4 mg sublingual/rectal)
3. Methylergometrine (0.2 mg IM)
4. Carboprost (0.25 mg/mL IM)
5. Carbetocin (100 mcg slow IV)
Europe Finland n/a n/a • Oxytocin (50 IU) or Cytotec (600–1200 mcg) administered rectally every 3–4 hours n/a
Europe France 2004 Link

• Oxytocin

Vaginal and caesarean deliveries
• Syntocinon (10 IU IM or 5 IU slow IV infusion)
Europe Italy 2009 n/a

• Oxytocin

Vaginal and caesarean deliveries
• Oxytocin (10 IU IM or 5 IU IV) or syntometrine immediately after delivery of the baby or before removal of the placenta, followed by oxytocin (5–20 IU IV fusion in 500 mL of physiologic solution)
Europe Norway 2014 Link

• Oxytocin 5 IU IM (repeat once, if necessary)

Vaginal and caesarean deliveries
• Oxytocin 5 IU IM
Europe Poland 2013 n/a 1. Oxytocin
2. Carbetocin
n/a
Europe Portugal n/a n/a • Oxytocin n/a
Europe Romania 2009 Link • Oxytocin or methylergometrine Vaginal and caesarean deliveries
• Oxytocin or methylergometrine
Europe Russia 2013 Link

1. Carbetocin 100 mcg IM or oxytocin 20 IU IM
2. Misoprostol is used in approximately 20% cases of PPH

Vaginal and caesarean deliveries
1. Carbetocin 100 mcg and oxytocin (5–10 IU IV infusion)
Europe Spain 2006 Link

1. Oxytocin
2. Methylergometrine
3. Carboprost (Hemabate) or misoprostol

Vaginal and caesarean deliveries
• Oxytocin
Europe Sweden n/a n/a • Oxytocin n/a
Europe Switzerland n/a Link • Oxytocin or carbetocin Vaginal and caesarean deliveries
• Oxytocin, carbetocin or misoprostol
Europe Turkey n/a n/a • Oxytocin (40–60 IU IV infusion)
• Methylergometrine (0.2 mg IM every 3–4 hours, 4–6 times)
• Misoprostol tablets (1000 mcg rectally or 400–800 mcg sublingually)
Vaginal and caesarean deliveries
• Oxytocin (5–10 IU IM or IV Infusion)
• Methylergometrine (0.2 mg IM)
Europe United Kingdom 2009 Link

• Syntocinon (5 IU slow IV bolus)
• Ergometrine (0.5 mg slow IV or IM bolus)
• Syntocinon (40 IU IV infusion in 500 mL Hartmann's solution at a rate of 125 mL/hour)
• Carboprost (0.25 mg IM repeated at intervals of no less than 15 min). Maximum of 8 doses (2 mg)
• Carboprost (0.5 mg intramyometrial injection)
• Misoprostol (1000 mcg rectally)

Vaginal deliveries
• Oxytocin (5 IU or 10 IU by IM)

Caesarean deliveries
• Oxytpocin (5 IU slow IV bolus)
• Syntometrine (in the absence of hypertension)
• Misoprostol (if oxytocin is not available, such as home-birth setting)

Latin America Argentina n/a n/a • Oxytocin (10/20 IU IM)
• Ergometrine (0.2 mg IM)
• Syntometrine
• Misoprostol (400–600 mcg)

n/a

Latin America Brazil 2010 n/a

1. Oxytocin (10 IU IM, 20–40 IU IV in 6 hours). Maintenance dose of 20 IU IV over 8 hours)
2. Ergometrine (0.2 mg IM). A second dose can be give after 15 min if required. Maintenance dose of 0.2 mg IM over 4 hours (total dosage should not exceed 1 mg)
3. Misoprostol (200–800 mcg sublingual). Do not exceed 800 mcg

Vaginal and caesarean deliveries
1. Oxytocin (10 IU IV or IM after delivery)
Latin America Mexico 2010 Link

• Oxytocin (10–40 IU IV in 1000 mL saline)
• Ergometrine (0.2 mg IM or IV)
• Carbetocin (100 mcg single IV bolus)
• Misoprostol (800 mg sublingually or rectally)
• Tranexamic acid acid

Caesarean deliveries
• Oxytocin (10–40 IU IV in 1000 mL saline)
• Carbetocin 100 mcg/min IV can be used in elective caesarean section instead of oxytocin
Asia China 2009 Link • Oxytocin (10 IU IM, 5 IU IV or 10 IU IV infusion in 500 mL of liquid at a rate of 100–150 mL/hour) Vaginal and caesarean deliveries
1. Oxytocin (10 IU IM, 5 IU IV or 10 IU IV infusion in 500 mL of liquid at a rate of 100–150 mL/hour)
2. Controlled cord traction, cord clamping and cutting
3. Uterine massage
Asia Malaysia n/a n/a

1. Oxytocin (5 IU IV). Total of 40 IU infused over 24 hours

n/a
Asia South Korea n/a n/a n/a Vaginal and caesarean deliveries
• Oxytocin (5 IU slow IV infusion)
Asia Thailand 2011 n/a 1. Oxytocin (10 IU IM, 5 IU IV or 10–20 IU IV infusion in 1000 mL saline at a rate of 100–150 mL/hour) 2. Methylergometrine n/a
Asia The Philippines 2014 n/a 1. Oxytocin IV 2. Carbetocin (100 mcg IM or IV over 1 min) or • Methylergometrine (0.2 mg IM every 2–4 hours). Maximum of 5 doses (1 mg) for 24-hour period or • Carboprost (0.25 mg IM every 15 min). Maximum of 8 doses (2 mg) Vaginal and caesarean deliveries
1. Oxytocin (10 IU IM or 5 IU slow IV)
2. Carbetocin (100 mcg IM or IV over 1 min) or
• Methylergometrine (0.2 mg IM every 2–4 hours). Maximum of 5 doses (1 mg) for 24-hour period
Asia Vietnam 2012

n/a

1. Controlled cord traction
2. Carbetocin 100 mcg IM or IV in high-risk patient groups
Caesarean deliveries
• Uterine massage
• Oxytocin (5 IU IV infusion in 500 mL solvent). Maximum of 80 IU
• Methylergometrine (0.2 mg IV or IM). Maximum of 5 doses (1 mg). Contraindicated for hypertension and Raynaud symptom
• Carbetocin (100 mcg)
• PGEF2α (250 mcg IM). Total dose 2 mg. Contraindicated for asthma and hypertension
• PGE1 (800 mcg rectally)
Australasia Australia 2012 Link

• Syntocinon, ergometrine or misoprostol (rectally)

Elective caesarean deliveries
• Consider using carbetocin 100 mcg IV in 1 mL, given slowly over 1 min after birth of the baby

Carbetocin is currently not indicated in emergency caesarean section or after vaginal birth

Australasia New Zealand 2011 n/a • Syntocinon, ergometrine, misoprostol (rectally) or prostaglandins n/a
North America Canada 2010 Link

1. Oxytocin (10 IU IM or 20–40 IU IV infusion at a rate of 500–1000 mL/hour)
2. Hemabate
3. Carbetocin (100 mcg IM or IV over 1 min)
4. Misoprostol (400–1000 mcg)

Caesarean deliveries
• Carbetocin (100 mcg IV bolus over 1 min)

Vaginal deliveries
• Carbetocin (100 mcg IM)

North America United States 2006 Link 1. Oxytocin (10 IU IM or 10–40 IU IV infusion in 1000 mL saline)
2. Methylergometrine (0.2 mg IM every 2–4 hours)
3. Hemabate (0.25 mg IM every 15–90 min). Maximum of 8 doses (2 mg)
4. Prostin (20 mg vaginally or rectally every 2 hours)
5. Cytotec (800–1000 mcg rectally)
Vaginal and caesarean deliveries
1. Oxytocin (10 IU IM or 10–40 IU IV infusion in 1000 mL saline)
2. Methylergometrine (0.2 mg IM every 2–4 hours)
3. Carboprost (Hemabate; 0.25 mg IM every 15–90 min). Maximum of 8 doses (2 mg)
4. Prostin (20 mg vaginally or rectally every 2 hours)
5. Cytotec (800–1000 mcg rectally)
Middle East Israel 2013 n/a • Oxytocin or prostaglandins Vaginal and caesarean deliveries
• Oxytocin or prostaglandins
Middle East Lebanon 2012 n/a 1. Oxytocin Vaginal and caesarean deliveries
1. Oxytocin (5–10 IU IV followed by continuous IV infusion of 20–30 IU)
2. Misoprostol (200 mcg)
3. Methylergometrine
4. Prostin
Middle East Saudi Arabia 2013 Link n/a Use oxytocic drugs that can be given together or sequentially for vaginal and caesarean deliveries
• Oxytocin (10 IU IM or 20 IU IV infusion in 1000 mL fluid at a rate of 60 drops/min)
• Ergometrine (0.2 mg IM or slow IV). A second dose of 0.2 mg IM can be given after 15 minutes if required or a second dose of 0.2 mg slow IV given every 4 hours. Maximum of 5 doses (1 mg)
• PGFα (0.25 mg IV given every 15 min). Maximum total dose of 2 mg
Africa South Africa n/a n/a n/a

Caesarean deliveries
• Oxytocin (10 IU IV bolus, followed by a continuous infusion of 20–30 IU IV infusion)

Vaginal deliveries
• Oxytocin (10 IU IM)

Worldwide World Health Organization 20112 Link

Pharmacological methods
1. Oxytocin IV
2. Ergometrine IV, syntometrine or prostaglandin (including misoprostol 800 mcg sublingual)
3. Tranexamic acid

Vaginal and caesarean deliveries
1. Oxytocin (10 IU IV or IM)
2. Ergometrine/methylergometrine, syntometrine or misoprostol (600 mcg orally)
Worldwide International Federation of Gynecology and Obstetrics 2012 Link

• Oxytocin (10 IU IM, 5 IU slow IV bolus or 20–40 IU IV infusion)
• Misoprostol (800 mcg sublingually)
• Ergometrine/methylergometrine (0.2 mg IM). Repeat dose every 2–4 hours if required. Maximum total dose of 1 mg per 24-hour period
• Syntometrine IM
• Carbetocin (100 mcg IM or IV over 1 min)
• Carboprost (0.25 mg every 15 min). Maximum of 8 doses (2 mg)

1. Oxytocin (10 IU IM or 5 IU slow IV bolus)
2. Ergometrine/methylergometrine (0.2 mg IM)
3. Misoprostol (600 mcg orally)