产妇在分娩第二阶段的定位及其与围外伤的关系:系统性审查和网络元分析
Estíbaliz Laderas-Díaz1,2, Julián Rodríguez-Almagro3,4, Sandra Martínez-Rodríguez5,2
1Department of Obstetrics & Gynaecology, General Hospital, Ciudad Real, Spain.
International urogynecology journal
|January 22, 2026
概括
在分娩期间母亲的位置不会显著影响周围裂或表皮切割率. 诸如坐等特定的姿势可能会降低风险,但证据有限,强调个性化护理和患者在分娩位置选择中的偏好.
科学领域:
- 产科和妇科 产科和妇科
- 围产期护理 围产期护理
- 基于证据的医学基于证据的医学.
背景情况:
- 围外伤是分娩的一个常见并发症.
- 在分娩的第二阶段,母亲的位置可能会影响周围裂的发生率和外皮切割的必要性.
- 对分娩位置的综合证据对于优化母亲的结果至关重要.
研究的目的:
- 进行随机对照试验 (RCT) 的网络元分析 (NMA).
- 为了比较不同母亲的位置在第二阶段的劳动与周围撕裂 (1号,2号和3号/4号度) 和表皮切割的关联.
- 为临床实践和共同决策提供基于证据的指导.
主要方法:
- 在2024年6月之前,对主要数据库中识别的RCT进行系统审查和NMA.
- 包括9个RCT,共7621名参与者.
- 聚合几率比率 (ORs) 和95%置信区间 (CI) 计算了直立与仰卧/石解剖位置,并对单个位置进行了网络分析.
主要成果:
- 在直立和仰卧/石切位置之间,没有发现第1,2,或第3/4度围撕裂或表皮切割的显著差异.
- 网络分析表明,站立是第一级伤的最低风险位置 (SUCRA 79.1%),在第二级和第三级/第四级伤 (SUCRA 93.9%和94.3%),以及手和膝盖进行表皮切割 (SUCRA 100%).
- 这些特定位置的发现基于有限的数据,需要谨慎的解释.
结论:
- 目前的综合证据表明,直立和仰卧/石切割分娩位置之间的围外伤或表皮切割率没有显著差异.
- 虽然网络估计暗示了特定立场的潜在好处,但证据有限且异质.
- 母亲的偏好,舒适度和个人风险因素应指导分娩位置的选择,支持共享决策.
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