自由体位结合会阴无保护分娩在第二产程应用效果的Meta分析

Effects of free position combined with "hands off" technique in the second stage of labor:a Meta-analysis

目的:系统评价产妇在第二产程中采取自由体位结合会阴无保护分娩技术对分娩效果的影响。方法:计算机检索PubMed、EMbase、Web of Science、中国生物医学文献数据库、中国知网、维普和万方数据库中关于自由体位结合会阴无保护分娩的临床随机对照试验,检索时间为建库至2021年1月。由2名评审员独立完成文献筛选和质量评价后,使用RevMan 5.2软件进行Meta分析。结果:共纳入12篇随机对照试验,涉及3146例产妇。Meta分析结果显示,自由体位结合会阴无保护分娩能降低会阴切开率[RR=0.28,95%CI(0.17,0.47),P<0.00001],缩短第二产程时长[MD=-18.77,95%CI(-20.78,-16.77),P<0.00001],降低新生儿窒息率[RR=0.36,95%CI(0.17,0.74),P=0.006],提高会阴完整率[RR=4.65,95%CI(3.24,6.67),P<0.00001],增加会阴Ⅰ度裂伤率[RR=3.68,95%CI(1.72,7.86),P=0.0008];对于会阴Ⅱ度裂伤和产后2 h出血量,合并效应量差异无统计学意义(P>0.05)。结论:现有证据表明,自由体位结合会阴无保护分娩可以降低产妇会阴切开率,保护会阴完整性,缩短第二产程时间,降低新生儿窒息率,增加会阴Ⅰ度裂伤率。但本研究纳入文献质量均为中等,今后仍有待于大样本、多中心和高质量的随机对照试验来验证此方法的临床效果。

Objective:To systematically evaluate the effects of free position combined with"hands off"technique in the second stage of labor.Methods:Randomized controlled trials on free position combined with"hands off"technique were retrieved from the PubMed,EMbase,Web of Science,CBM,CNKI,VIP and WanFang Data.The retrieval time was from database establishment to January 2021 After two reviewers independently completed literature screening and quality assessment,RevMan 5.2 software was used for Meta-analysis.Results:Twelve randomized controlled trials were included,involving 3146 parturient women.Meta-analysis results showed that free position combined with"hands off"technique can reduce the rate of episiotomy[RR=0.28,95%CI(0.17,0.47),P<0.00001],shorten the time of the second labor[MD=-18.77,95%CI(-20.78,-16.77),P<0.00001],reduce the rate of neonatal asphyxia[RR=0.36,95%CI(0.17,0.74),P=0.006],improve the perineum integrity[RR=4.65,95%CI(3.24,6.67),P<0.00001],and increase the rate of perineal lacerationⅠdegrees[RR=3.68,95%CI(1.72,7.86),P=0.0008].There was no significant difference in perineal lacerationⅡdegrees and the 2 h postpartum bleeding volume.Conclusion:Current evidences shows that free position combined with"hands off"technique can reduce episiotomy rate,protect the perineum integrity,shorten the time of the second labor,reduce the incidence of neonatal asphyxia,increase the rate of perineal lacerationⅠdegrees.However,the quality of the included literatures in this study is moderate.In the future,large sample,multicenter and high-quality randomized controlled trials are still needed to verify the clinical effect of this method.