世卫组织关于预防,检测和治疗产后出血的指导方针的实施策略
Katherine Semrau1,2, Ethan Litman3, Rose L Molina1,3
1Ariadne Labs, Brigham and Women's Hospital, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
The Cochrane database of systematic reviews
|February 26, 2025
概括
多组分策略可能会改善对分娩后出血 (PPH) 准则的遵守,但证据的确定性较低. 需要更多的研究来了解PPH预防和治疗的实施效果.
科学领域:
- 产科和妇科 产科和妇科
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 世界卫生组织 (WHO) 关于产后出血 (PPH) 预防,检测和治疗的指南面临实施挑战.
- 需要有效的策略来改善对PPH临床指南的遵守.
研究的目的:
- 评估实施战略的临床益处和危害,促进遵守世卫组织PPH指南.
- 评估这些战略对PPH结果和实施指标的影响.
主要方法:
- 系统性审查包括随机对照试验 (RCT) 和非随机干预研究 (NRSI).
- 搜索了多个数据库,直到2024年4月,包括Cochrane CENTRAL,MEDLINE,Embase和CINAHL.
- 使用RoB 2和ROBINS-I工具评估偏差风险;使用GRADE评估证据的确定性.
主要成果:
- 与增强的常规护理相比,多元组件策略可以改善对PPH预防和治疗指南的遵守.
- 证据的确定性低至非常低,对PPH体积,输血或严重的孕产妇发病率等临床结果的数据有限.
- 单组分策略显示效果有限,没有研究报告了额外的子宫激动剂或不良影响.
结论:
- 多元组件实施策略显示了改善PPH准则遵守的潜力,但可靠的结论受到低确定性证据的限制.
- 建议使用混合有效性实施设计进行进一步的研究,以了解影响实施的上下文因素.
- 在大多数研究中使用的"培训和教育"策略,在单独使用时似乎有限.
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