مقایسه تأثیر دوشیدن بند ناف با دو روش تزریق وریدی اکسی توسین و نرمال سالین، بر طول مدت مرحله سوم زایمان

نویسندگان
پروین احسانی
رضیه حاتمی راد
چکیده
زمینه و هدف

خونریزی هنوز یکی از علل مهم مرگ حین زایمان مادران در کشورهای در حال توسعه است. هدف از این مطالعه بررسی دوشیدن خون موجود در عروق بند ناف، به سمت جفت، و مقایسه این روش با دو روش تزریق نرمال سالین با و بدون اکسی توسین در ورید نافی از نظر تأثیر بر طول مرحله سوم زایمان و در نتیجه کاهش خونریزی بوده است.

مواد و روش ها

مطالعه از نوع کارآزمایی بالینی تصادفی کنترل شده روی 168 مورد زایمان طبیعی در بیمارستان های اهواز صورت گرفت. در گروه اول ( 56 نفر ) خون بند ناف به طرف جفت دوشیده شد. در گروه های دوم ( 44 نفر ) و سوم ( 32 نفر ) به ترتیب، 20 واحد اکسی توسین رقیق شده و 30 سی سی نرمال سالین در ورید بند ناف تزریق شد و برای 36 نفر، به عنوان گروه کنترل، 20 واحد اکسی توسین در 1000 سی سی سرم رینگر انفوزیون شد. داده ها با استفاده ازنرم افزار SPSS v.16 و تست های آمار توصیفی، تی زوجی و آنالیز واریانس، و با سطح اطمینان 95 درصد، تجزیه و تحلیل شدند.

یافته ها

میانگین زمان مرحله سوم بین گروه های مطالعه اختلاف معنی دار آماری داشته است ( 002 / P = 0 ). با استفاده از تست تعقیبی توکی نشان داده شد که این اختلاف بین گروه های مداخله با گروه کنترل بوده است. ولی گروه های مداخله از این نظر تفاوت آماری با هم نداشته اند. یعنی مداخله دوشیدن بند ناف مشابه مداخلات دیگر طول مرحله سوم زایمان را کاهش داد. مقایسه میانگین هموگلوبین مادران قبل و بعد از زایمان بین همه گروه ها تفاوت معنی داری نداشت.

نتیجه گیری

روش دوشیدن بند ناف، می تواند مشابه تزریق اکسی توسین رقیق شده و نرمال سالین تنها، طول مرحله سوم زایمان را کاهش دهد. مزیت استفاده از این روش سهولت و راحتی آن است.



* نویسنده مسئول: دانشگاه آزاد اسلامی واحد اهواز.

پست الکترونیک: Ehsani81@yahoo.com
کلیدواژه‌ها
بند ناف
اکسی توسین
محلول ایزوتونیک
مرحله سوم زایمان

عنوان مقاله English

Comparing the Effect of Umbilical Cord Milking Versus Vein Oxytocin Injection and Normal Saline Injection, on Third Stage of Labor

نویسندگان English

Parvin Ehsani
Razieh Hatamirad
چکیده English

Introduction and Aims

One of the most important causes for maternal death in developing countries is the third stage bleeding. The main aim of this study is to compare the effect of milking umbilical cord with diluted oxytocin and normal saline injections in the umbilical cord vein, on labor third stage duration and bleeding.

Materials and Methods

The randomized control trial was done on 168 parturient mothers in Ahvaz hospitals. In the first group (N = 56) the umbilical cord blood was milked toward the placenta, the mothers in second group (N = 44) and third group (N = 32) were received 20 IU oxytocin and 30 ml saline normal in umbilical cord vein, respectively. Finally the forth or control group (N = 36) were received infusion of 20 IU oxytocin in 1000 ml serum ringer as the routine postpartum care. Then collected data was analyzed in SPSS v.16 by statistical tests, paired t-test, and ANOVA (CI = 95%).

Results

Mean duration of third stage of labor was significantly different between groups (P = 0.02), but all three manipulated groups did not have any significantly difference whereas, the difference was between control and manipulated groups. The effect of milking the umbilical vein toward placenta, is similar to the other manipulations in third stage duration. Mean hemoglobin concentration was not importantly different between the groups.

Conclusion

Milking the umbilical cord blood toward placenta could reduce the duration of labor third stage the same as the others (diluted oxytocin and saline normal in umbilical vein). While this new method is easier and more available.



* Corresponding Author: Ahvaz Islamic Azad University.

E-mail: Ehsani81@yahoo.com

کلیدواژه‌ها English

Umbilical Cord
Oxytocin
Isotonic Solution
Labor Stag Third
Williams obstetrics. 23rd ed. Cunningham FG, Williams JW. New York: McGraw-Hill; 2010, 201-30.

Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev. 2013.

Mercer JS. Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Women’s Health. 2001:46(6):402-14.

Kovavisarach E, Rojsangruang S. Effect of umbilical vein oxytocin injection on tne third stage of labor: a randomixed controlled study. J Med Assoc Thai. 1998;81(9):693-7.

World health organization, attending to 136 million births every year: make every mother and child count. Geneva: Global Forum for Health Research; 2005. Available from: URL: http://announcementsfiles.cohred.org/gfhr_pub/assoc/s14881e/s14881e.pdf.

Bennett VR, Brown LK. Myles text book formidwives.14th ed. London: Churchill Livingston; 2003, 462-77.

Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynaecol Obstet. 2006;94(3):47-50.

Athavale RD, Nerurkar NM, Dalvi SA, Bhattacharya MS. Umbilical vein oxytocin in the management of third stage of labor. J Postgrad Med. 1991;37(4):219-20.

Danesh MM, Sahhosseini Z, Abedian Kasgary K. Umbilical venous administration of different dosages of saline on the length of the third stage of labor. J Mazandaran Univ Med Sci. 2006;16(55):35-41.

Mahani MA, Ghasemi A, Ghaemi S. The effect of umbilical vein oxytocin injection on third stage of labor time and postpartum hemmorrahge. J Qazvin Univ Med Sci. 2006;10(1):52-6. [Persian]

Nazarpoor S. [Comparing the effect of placental blood drainage and oxytocin injection into the umbilical cord vein on third stage of labor]. Kowsar Med J. 2008;13(1):71-8. [Persian]

Güngördük K, Asicioglu O, Besimoglu B, Güngördük OC, Yildirm G, Ark C, et al. Using intraumbilical vein injection of oxytocin in routine practice with active management of the third stage of labor: a randomized controlled trial. Obstet Gynecol. 2010;116(3):619-24.

Mori R, Nardin JM, Yamamoto N, Carroli G, Weeks A. Umbilical vein injection for the routine management of third stage of labour. Cochrane Database Syst Rev. 2012.

Sayahmelli, M, Satarzadeh, N. Effect of oxytocin intraumblical injection on labor third stage dutation and post-partum hemorrhage. Proceedings of the 4th International Congress of Gyneco-Obstetric. 2003. Iran. [Persian]

Reddy W, Carry JC. Efffect of umbilical vein oxytocin on puerperal bloodloss and lengtn of third stage or labor. Am J Obstet Gynecol. 1989;160(1):206-8.

Porter KB, O'Brein WF, Collins MK, Givens P, Knuppel R, Bruskivage L. A randomized comparison of umbilical vein and intravenous oxytocin during the puerperium. Obstet Gynecol. 1991;78(2):254-6.

Choy CM, Lau WC, Tam WH, Yuen PM. A randomised controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour. Br J ObstetGynecol. 2002;109(2):173-7.

Akins S. Postpartum hemorrhage. A 90s approach to an age-old problem. J Nurse Midwifery. 1994;39:123-34.

Makvandi S, Zargar Shoshtari Sh, Yadolahi P. Effect of diluted intraumbilical administration of oxytocin on the third stage of labor: a randomized clinical trial. Jundishapur Scientific Medical Journal, 2013;12(1):51-8. [Persian]

Surgi N, BagheriNejad Z. Effect of early and late clamping of umbilical cord on length of the third stage of labor. Modern Care J. 2005; 2(3-4):36-40. [Persian]

Kore S, Srikrishna S, Hedge A, AmbiyeVR, Vaidya PR. Active management of third stage of labour with intraumbilical oxytocin injection. J Obstet Gynaecol India. 2000;50(3):54-5.

Dahiya P, Puri M, Rathee S. Influence of intraumbilical oxytocin on the third stage of labour. Indian J Med Sci. 1995;49(2):23-7.

Golan A, Lidor AL, Wexler S, David MP. A new method for the management of the retained placenta. Am J Obstet Gynecol. 1983;146(6):708-9.

Aaghajani Delavar M, Mohammadpoor RA. Management of the third stage of labor__AWT_NOKT_COMMA__ The effect of early and late umbilical cord clamping and injection of Oxytocin. J Babol Univ Med Sci. 2003;5(2):24-7. [Persian]

Soltani H, Poulose TA, Hutchon DR. Placental cord drainage after vaginal delivery as part of the management of the third stage of labour, Cochrane Database Syst Rev. 2011;(9).

Razmkhah N, Kordi M. Effect of cord potency on duration of the third stage of delivery. J Mashhad School Nurs Midw. 1990;1(2):45-7. [Persian]

Shabiri F, Mohammadi N, Nazari M. The effect of some factors on duration of third stage of labor. Sci J Hamdan Univ Med Sci. 2010;17(1-2):9-12. [Persian]

Mikolajczyk RT, Zhang J, Troendle J, Chan L. Risk factors for birth canal lacerations in primiparous women. Am J Perinatol. 2008;25(5):259-64.

Tessier V, Pierre F, Collège National des Gynécologues et al. Obstétriciens Français, Agence Nationale d'Accréditation et d'Evaluation en Santé. Risk factors of postpartum hemorrhage during labor and clinical and pharmacological prevention. J Gynecol Obstet Biol Reprod (Paris). 2004;33.

Soltan MH, Ibrahim EM, Tawfek M, Hassan H, Farag F. Raised nitric oxide levels may cause atonic postpartum hemorrhage in women with anemia during pregnancy. Int J Gynaecol Obstet. 2012;116(2):143-7.

Nasohi J, FalakAflaki B. The magnitude of hemoglobin-drop in obstetrics and gynecologic operations. Is routine Hb check necessary?. Sci J Hamdan Univ Med Sci. 2003;4(30):43-6. [Persian]

Abbaspoor Z, Vaziri L, Imam J. Sensitivity and specificity collector bag for the measurement of post-partum hemorrhage. Guilan Univ Med Sci. 2012;21(83):58-64. [Persian]

Fazel N, Esmaeili H, ShamaeianRazavi N. Effect of cumin oil on postpartum hemorrhage after cesarean. Iranian Journal of Medical and Aromatic Plants. 2014;29(1):97-104. [Persian]