早期常规人工破膜对产程及胎儿与新生儿影响的Meta分析

Effects of routine early amniotomy on labor and health status of foetus and neonate: a meta-analysis

目的探讨产程中早期常规人工破膜对产程及胎儿或新生儿的影响。方法对“早期人工破膜可增加胎儿心率异常的发生[1]、早期人工破膜的随机化对照试验[2]、早期人工破膜对初产妇发生难产危险的影响[3]、选择性人工破膜对胎心率及产程影响的随机研究[4]、比较早期人工破膜与选择性人工破膜对正常产程影响的临床随机研究[5]和关于产程中主动管理的临床随机研究和Meta分析[6]”等6篇文献中的临床随机对照试验结果,使用固定效应模型方法进行Meta分析。结果(1)早期常规人工破膜能够缩短第一产程95min,95%可信区间(CI)为-119·17^-70·52。(2)没有足够证据表明早期常规人工破膜能够对分娩方式产生影响:剖宫产率OR=1·25,95%CI为0·99~1·57,器械阴道助产率OR=1·05,95%CI为0·90~1·24。(3)早期常规人工破膜对第一产程胎心率异常的发生没有影响(OR=0·95,95%CI为0·75~1·21),但增加第二产程胎心率异常的发生(OR=1·28,95%CI为1·02~1·61)。(4)没有足够证据表明早期常规人工破膜能够对羊水胎粪污染的发生产生影响(OR=1·17,95%CI为0·78~1·73),但可能降低新生儿1分钟Apgar评分<7分的发生率(OR=0·71,95%CI为0·49~1·03)。结论常规早期人工破膜可缩短产程,并可能减少新生儿1分钟Apgar评分<7分的发生;但增加第二产程胎心率异常的发生以及有可能会增加剖宫产率。

Objective To analyze the effects of routine early amniotomy on labor and health status of foetus and neonate. Methods The results of ＂Early amniotomy increases the frequency of fetal heart rate abnormalities, A randomized controlled trial of early amniotomy, Effect of early amniotomy on the risk of dystocia in nulliparous women, The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients： A randomized study, Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term and A randomized controlled trial and meta-analysis of active management of labour were analyzed using Mantel-Haenszel method （fixed effect model） in metaanalysis. Results （ 1 ） The routine early amniotomy can shorten 94. 90 min of the first stage of labor, 95% CI （ - 119. 17, -70.52）. （2） The OR for cesarean section was 1.25,95% CI （0.99 - 1.57）,for instrumental vaginal delivery was 1.05, 95% CI （0. 90 -1.24）. （3） There was no difference in abnormal fetal heart rate at first stage （ OR =0. 95, 95% CI： 0. 75 - 1.21 ）, but there was increased abnormal fetal heart rate at second stage（ OR = 1.28, 95% CI： 1.02 - 1.61 ）. （4） The frequency of stained amniotic fluid and abnormal Apgar scores at 1 minute was not different significantly [ OR = 1.17,95% CI （0. 78 - 1.73） ; OR = 0. 71,95% CI： （ 0. 49 - 1.03 ） ]. Conclusions Routine early amniotomy appears to be associated with both benefits and risks. Beneficial effects include reductions in labor duration and possible decrease in frequency of abnormal Apgar score at one minute. Risks include increase in abnormal fetal heart rate at second stage and possible rise in cesarean section rate.