在剖腹产产时受冲击的胎儿头部的管理:系统性审查和元分析
Katie Cornthwaite1,2, Jan W van der Scheer3, Sarah Kelly3
1Royal College of Obstetricians & Gynaecologists, London, UK.
Acta obstetricia et gynecologica Scandinavica
|May 24, 2024
概括
目前的证据不足以建议在剖腹产期间管理受冲击的胎儿头部的具体技术. 需要高质量的培训,未来的研究应该建立对受影响胎儿头部管理的标准化定义和结果.
科学领域:
- 产科和妇科 产科和妇科
- 手术技巧 手术技巧
- 基于证据的医学基于证据的医学.
背景情况:
- 剖腹产产期间胎儿头部受损的发病率越来越高,因此需要有效的预防和管理策略.
- 缺乏高质量的证据审查阻碍了选择最佳技术.
- 现有的研究还没有明确地定义在宫完全扩张之前或在宫分娩之前剖腹产时受冲击的胎儿头部最有效的方法.
研究的目的:
- 确定,评估和综合研究,比较预防或管理剖腹产时受影响的胎儿头部的技术.
- 评估不同干预方法的有效性和安全性.
- 解决目前在剖腹产期间对受影响胎儿头部管理的证据缺口.
主要方法:
- 在MEDLINE,Emcare,Embase和Cochrane数据库中进行全面的文献搜索,截至2023年1月.
- 包括随机对照试验和非随机比较研究 (每组≥30).
- 使用RoB2,ROBINS-I和GRADE进行证据评估的偏差风险和确定性,并酌情进行元分析.
主要成果:
- 分析了24项研究 (11项RCT,13项非随机) 涉及3558名女性,比较了诸如阴道切除,逆抽取,帕特沃丹方法和胎儿枕头等技术.
- 在七次比较中,所有96个结果的证据确定性都很低或非常低.
- 聚合分析显示,技术之间没有显著差异,由于确定性低和潜在偏差,一些对母亲的结果基于不可靠的估计.
结论:
- 目前的证据基础很弱,因此无法就任何冲击胎儿头部技术的优越性做出明确的建议.
- 各种技术的高质量培训对医疗保健提供者至关重要.
- 未来的研究迫切需要建立标准化的定义,结果集,并遵守国际报告标准对受影响的胎儿头部管理.
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