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对III类肥胖患者的产前干预:系统性审查和元分析

Michelle A Kominiarek¹, Mariana Espinal¹, Irina R Cassimatis²

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Kominiarek and Espinal).

American journal of obstetrics & gynecology MFM

|March 17, 2024

概括

对于肥胖 (体重指数≥40 kg/m2) 个体,基于证据的周周干预措施是有限的. 大多数研究发现,常见的干预措施,包括伤口关闭技术和负压伤口治疗,没有显著的益处.

科学领域:

产科和妇科产科和妇科
孕产妇和胎儿医学孕产妇和胎儿医学
减肥医学减肥医学

背景情况:

体重指数 (BMI) 40 kg/m2或更高的人面临周周风险增加.
在这个人群中,以证据为基础的干预措施来优化周产期结果是稀缺的.
优化对高BMI怀孕的护理对于母亲和婴儿的福祉至关重要.

研究的目的:

识别和评估基于证据的围产阶段干预措施,针对BMI≥40kg/m2的个体.
综合各种干预措施的有效性发现,重点关注剖腹产后的伤病率.
为肥胖人口提供围产期护理最佳实践指南.

主要方法:

在多个数据库 (PubMed,MEDLINE,EMBASE,Cochrane,CINAHL,ClinicalTrials.gov) 进行了系统的文献搜索,直到2022年.
包括队列和随机对照试验,评估BMI≥40 kg/m2的个体的周边干预措施.
对至少有两项研究的干预措施进行了元分析,报告了汇总的风险比率和置信区间.

主要成果:

包括30项涉及10种类型干预的研究. 与计划性阴道分娩相比,计划性剖腹产并没有改善结果.
用带或 sutures 关闭的子皮膜没有显示出伤口发病率的差异. 预防性负压伤口治疗也没有显示任何益处.
对这一群体进行干预的证据有限,大多数研究显示没有显著的优势.

结论:

在BMI≥40kg/m2的个体中,对周产期干预的高质量研究很少.
目前的证据不支持在这个群体中剖腹产后常规使用预防性负压伤口治疗.
建议用或钉来关闭子皮层伤口,根据现有数据没有明确的偏好.

关键词:

这是一种抗凝血药物.身体质量指数 (BMI) 是什么?剖腹产分娩技巧剖腹产分娩技巧劳动的诱导劳动的诱导.预防性抗生素抗生素伤口并发症伤口并发症

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