非传统卧位对足月头先露胎膜早破母儿影响的Meta分析

Perinatal Outcomes for PROM in Term Pregnancies With Cephalic Presentation Taking Non-conventional Supine Position:A Systematic Review and Meta-analysis

目的探讨足月头先露胎膜早破患者采取自由体位或手膝卧位的安全性。方法以"胎膜早破(PROM)"、"脐带脱垂"等关键词检索2017年1月前Pubmed,Web of Science,中国生物医学文献数据库,中国知识资源总库、维普、万方等数据库,按照Cochrane系统评价方法,用Rev Man 5.3软件进行Meta分析。结果纳入10篇随机对照试验,共1 528例患者,观察组采用自由体位或手膝卧位,对照组采用传统卧位,Meta分析表明:自由体位或手膝卧位不增加脐带脱垂发生率(OR=0.33,95%CI:0.03~3.20,P=0.34),且能减少尿潴留(OR=0.12,95%CI:0.07~0.20,P<0.000 01;),降低剖宫产率(OR=0.30,95%CI:0.22~0.42,P<0.000 1)。结论现有研究表明足月头先露的胎膜早破患者采用自由体位或手膝卧位是安全可行的。

Objective To assess the security of different pre-labor position in term pregnancies with cephalic presentation following premature rupture of membranes（PROM）.Methods Date bases such as The Cochrane library,Pubmed,Web of Science,Chinese sinomed,CNKI,VIP and Wanfang database were searched with the keywords ＂premature rupture of the membrane＂ and ＂umbilical cord prolapse＂ or ＂maternal or neonatal outcome＂.Meta analysis were done by Rev Man 5.3 softwere.Results 10 randomized controlled trials and 1 528 patients were included.The experimental group take a liberal or handsupine knee position,while the control group take a conventional supine position.Compared to conventional group,the occurrence of umbilical cord prolapse in the liberal group were fair（OR=0.33,95%CI：0.03~3.20,P=0.34）,with a lower incidence of urinary retention and cesarean section（OR =0.12,95%CI ：0.07~0.20,P〈0.000 01;OR=0.30,95%CI：0.22~0.42,P〈0.000 1）.Conclusion For PROM in term pregnancies with cephalic presentation,liberal or handsupine knee position is safe and feasible.