Vplyv drenáže pupočníka po spontánnom pôrode na tretiu dobu pôrodnú

Download PDF English version

Authors: Erik Dosedla ¹; Petra Gašparová ¹; Zuzana Ballová ¹; M. Sitáš ¹; P. Calda ²
Authors‘ workplace: Department of Gynaecology and Obstetrics, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Hospital Agel Košice-Šaca Inc., Košice-Šaca, Slovak Republic ¹; Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine Charles University and General Teaching Hospital, Prague, Czech Republic ²
Published in: Ceska Gynekol 2023; 88(4): 260-263
Category: Original Article
doi: https://doi.org/10.48095/cccg2023260

Overview

Drenáž pupočníka zahŕňa uvoľnenie Peánových klieští z pupočníka po oddelení novorodenca z maternálneho konca pupočníka. Následne dochádza k vyprázdňovaniu krvi z placenty. Tento postup je súčasťou aktívneho vedenia III. doby pôrodnej (TSL – third stage of labor). Cieľ: Táto štúdia je určená na poskytnutie poznatkov o dĺžke trvania tretej doby pôrodnej a riziku retencie placenty pri použití drenáže pupočníka, a pri postupe bez drenáže pupočníka. Materiál a metodika: Prospektívnej randomizovanej štúdie manažmentu TSL sa zúčastnilo 600 pacientiek. Pacientky boli rovnomerne rozdelené do dvoch skupín s drenážou pupočníka (300) a bez drenáže pupočníka (300). TSL bola aktívne vedená odporúčaniami FIGO (the International Federation of Gynecology and Obstetrics). Sledovali sme trvanie TSL a retenciu placenty po 30 min. Výsledky: Priemerné trvanie TSL bolo 6,8 ± 0,4 min v skupine s drenážou a 11,6 ± 0,8 min v kontrolnej skupine. Dospeli sme k záveru, že drenáž pupočníka významne skracuje trvanie TSL (p = 0,026), ako aj znižuje riziko retencie placenty. V skupine, s použitou drenážou pupočníka sa retencia placenty 30 min po pôrode plodu vyskytla v čtyroch prípadoch, kým v druhom súbore sa vyskytla v 14 prípadoch (RR 3,62; 95% CI 1.18–11.14). Záver: Predpokladáme, že pri drenáži pupočníka dochádza ku kolabovaniu tenkostenných uteroplacentárnych ciev skôr, čo spôsobuje krvácanie z týchto ciev medzi placentu a stenu maternice, a týmto mechanizmom dochádza k včasnejšiemu odlúčeniu placenty. Samozrejme, že drenáž pupočníka je len jedným z krokov algoritmu aktívneho vedenia tretej doby pôrodnej podľa FIGO.

Klíčová slova:

III. doba pôrodná – drenáž placenty – manuálne vybavenie placenty – popôrodné krvácanie – retinovaná placenta

Sources

1. Afzal MB, Bushra N, Waheed K et al. Role of placental blood drainage as a part of active management of third stage of labour after spontaneous vaginal delivery. J Pak Med Assoc 2019; 69 (12): 1790–1793. doi: 10.5455/JPMA.302642458.

2. Güngördük K, Olgaç Y, Gülseren V et al. Active management of the third stage of labor: a brief overview of key issues. Turk J Obstet Gynecol 2018; 15 (3): 188–192. doi: 10.4274/tjod.39 049.

3. Yildirim D, Ozyurek SE, Ekiz A et al. Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial. Ginekol Pol 2016; 87 (5): 399–404. doi: 10.5603/GP.2016.0015.

4. Raams TM, Browne JL, Festen-Schrier VJ et al. Task shifting in active management of the third stage of labor: a systematic review. BMC Pregnancy Childbirth 2018; 18 (1): 47. doi: 10.1186/ s12884-018-1677-5.

5. Masuzawa Y, Kataoka Y, Fujii K et al. Prophylactic management of postpartum haemorrhage in the third stage of labour: an overview of systematic reviews. Syst Rev 2018; 7 (1): 156. doi: 10.1186/s13643-018-0817-3.

6. Whittington JR, Pagan M, Daugherty K et al. Duration of the third stage of labor and estimated blood loss in twin vaginal deliveries. AJP Rep 2020; 10 (3): e330–e334. doi: 10.1055/ s-0040-1715170.

7. Grillo-Ardila CF, Amaya-Guio J, Ruíz-Parra AI et al. Systematic review of prostaglandin analogues for retained placenta. Int J Gynaecol Obstet 2018; 143 (1): 19–23. doi: 10.1002/ijgo.12572.

8. Anteby M, Many A, Ashwal E et al. Risk factors and complications of manual placental removal after vaginal delivery – how common are additional invasive procedures? J Matern Fetal Neonatal Med 2019; 32 (3): 384–388. doi: 10.1080/14767058.2017.1379071.

9. Djakovic I, Djakovic Z, Bilić N et al. Third stage of labor and acupuncture. Med Acupunct 2015; 27 (1): 10–13. doi: 10.1089/acu.2014.1079.

10. Begley CM, Gyte GM, Devane D et al. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2015; 3: CD007412. doi: 10.1002/14651858.CD007412.pub.4.

11. Du Y, Ye M, Zheng F. Active management of the third stage of labor with and without controlled cord traction: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand 2014; 93 (7): 626–633. doi: 10.1111/aogs.12424.

12. Asicioglu O, Unal C, Asicioglu BB et al. Influence of placental cord drainage in management of the third stage of labor: a multicenter randomized controlled study. Am J Perinatol 2015; 32 (4): 343–350. doi: 10.1055/s-0034-1384639.

13. Roy P, Sujatha MS, Bhandiwad A et al. Placental blood drainage as a part of active management of third stage of labour after spontaneous vaginal delivery. J Obstet Gynaecol India 2016; 66 (Suppl 1): 242–245. doi: 10.1007/s132 24-016-0857-3.

14. Wu HL, Chen XW, Wang P et al. Effects of placental cord drainage in the third stage of labour: a meta-analysis. Sci Rep 2017; 7 (1): 7067. doi: 10.1038/s41598-017-07722-7.

15. Begley CM, Gyte GM, Devane D et al. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2019; 2 (2): CD007412. doi: 10.1002/ 14651858.CD007412.pub5.

16. Razmkhan N, Kordi M, Yousophi Z. The effects of cord drainage on the length of third stage of labour. J Nurs Midwifery 1999; 1: 10–14.

17. Vasconcelos FB, Katz L, Coutinho I et al. Placental cord drainage in the third stage of labor: randomized clinical trial. PLoS One 2018; 13 (5): e0195650. doi: 10.1371/journal.pone.0195650.

18. Karimi N, Molaee G, Esfahani NT et al. Placental cord drainage and its outcomes at third stage of labor: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22 (1): 570. doi: 10.1186/s12884-022-04877-8.