Efficacy of tranexamic acid combined with carbetocin in preventing placenta previa induced PPH and its impact on stress response and ovarian reserve function
Objective To explore the effect of tranexamic acid combined with carbetocin on stress response and ovarian reserve function in the prevention of placenta previa induced postpartum hemorrhage.Methods A retrospective study was conducted on 85 pregnant women with placenta previa admitted to Beijing Aerospace General Hospital from June 2018 to June 2023.The patients in the control group(n=39)were treated with cabezol oxytocin while those in the observation group(n=46)with cabezol oxytocin and tranexamic acid.The clinical efficacy,postpartum bleeding volume at different time points(0.5,2,12,24 h),duration of bleeding,hemodynamic indicators,coagulation function,stress response,ovarian reserve function,uterine recovery,and incidence of complications were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group(95.65%(44/46)vs 74.36%(29/39),χ2=7.892,all P<0.05).At 0.5,2,12 and 24 h postpartum,the bleeding volume in the observation group was lower than that in the control group((170.65±13.25)mL vs(181.52±14.20)mL,(214.65±32.50)mL vs(235.50±34.60)mL,(240.15±60.20)mL vs(290.15±55.60)mL,(267.90±45.65)mL vs(385.66±50.255)mL),and the duration of bleeding was shorter than that in the control group((31.50±6.40)d vs(40.15±6.35)d)(all P<0.05).After treatment,the heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)of the observation group were better than those of the control group((82.80±4.12)times·min-1 vs(88.10±4.10)times·min-1,(116.80±5.20)mm Hg(1 mm Hg≈0.133 kPa)vs(111.95±6.45)mm Hg,(80.50±5.05)mm Hg vs(76.60±5.10)mm Hg,(80.05±5.25)mm Hg vs(75.20±5.65)mm Hg,all P<0.05).After 24 and 72 hours of treatment,the activated partial thromboplastin time(APTT)and plasma prothrombin time(PT)of the observation group were lower than those of the control(24 h:(37.00±4.15)s vs(44.35±4.20)s,(10.20±1.20)s vs(13.80±1.25)s;72 h:(32.51±3.95)s vs(40.33±4.16)s,(9.26±1.04)s vs(11.18±1.13)s),while the levels of fibrinogen(FIB)and D-dimer(D-D)were higher than those of the control(24 h:(4.10±0.65)g·L-1 vs(3.20±0.50)g·L-1,(3.68±0.30)g·L-1 vs(3.02±0.35)g·L-1;72 h:(4.68±1.15)g·L-1 vs(3.70±1.10)g·L-1,(3.97±0.48)g·L-1 vs(3.36±0.51)g·L-1)(P<0.05).After treatment,the levels of adrenaline(AD),norepinephrine(NE)and cortisol(Cor)in the observation group were lower than those in the control((50.20±5.80)pg·mL-1 vs(68.75±6.50)pg·mL-1,(294.85±29.10)pg·mL-1 vs(350.98±32.90)pg·mL-1,(290.85±26.55)ng·mL-1 vs(350.90±28.65)ng·mL-1)(all P<0.05).At 3 and 6 months postpartum,the levels of follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Mullerian hormone(AMH)in the observation group were higher than those in the control(3 months:(8.20±1.01)mIU·mL-1 vs(6.10±1.02)mIU·mL-1,(7.88±1.11)mIU·mL-1 vs(6.35±0.98)mIU·mL-1,(99.60±10.25)pg·mL-1 vs(90.20±12.30)pg·mL-1,(3.10±0.60)ng·mL-1 vs(2.70±0.52)ng·mL-1;6 months:(7.85±1.12)mIU·mL-1 vs(5.02±0.95)mIU·mL-1,(7.09±1.04)mIU·mL-1 vs(4.81±0.79)mIU·mL-1,(91.53±8.77)pg·mL-1 vs(83.26±7.59)pg·mL-1,(2.87±0.45)ng·mL-1 vs(2.13±0.41)ng·mL-1)(all P<0.05).The amplitude,intensity,and tension of contractions in the observation group were all smaller than those in the control((240.86±115.34)mm vs(420.96±120.45)mm,(1 515.35±205.65)mm vs(1 775.65±210.52)mm,(1 420.25±135.20)mm vs(1 592.65±133.65)mm)(P<0.05).The incidence of complications in the observation group was lower than that in the control group(2.17%(1/46)vs 23.08%(9/39),χ2=6.984,P<0.05).Conclusion Cabecycline combined with tranexamic acid can effectively prevent PPH in placenta previa,stabilize hemodynamics,improve coagulation function,alleviate stress response,improve ovarian reserve function,and promote uterine recovery with few complications and high safety.
NETL
NSTL
万方数据
