摘要
目的系统分析过期妊娠及足月胎膜早破作为引产指征的证据。方法计算机检索Cochrane图书馆、PubMed、EMBASE,同时检索中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库和万方数据库,检索时间截止至2011年10月。收集过期妊娠和足月胎膜早破的随机对照研究,并按Cochrane协作网推荐的方法进行系统评价。结果对于过期妊娠共纳入17项研究7096人,Meta分析结果表明:对照期待治疗组,引产组的羊水粪染率低且差异有统计学意义(22.7%vs.28.2%,优势比0.75,95%可信区间0.66～0.84,P=0.02),引产组的剖宫产率、胎儿窘迫发生率、胎粪吸入、新生儿转新生儿重症监护室及围产儿死亡率均较期待治疗组低,但差异无统计学意义。对于足月胎膜早破纳入13项研究,比较米索前列醇引产与期待/安慰剂治疗组(5项),及米索前列醇与催产素引产(8项)的分娩结局。引产组较期待治疗组在12小时内分娩的比例明显高(相对危险度0.54,95%可信区间0.43～0.67,P﹤0.001),使用米索前列醇引产和使用催产素引产,12小时内分娩的比例无差异(相对危险度0.98,95%可信区间0.71～1.35,P=0.90)。其他指标剖宫产率、宫缩异常、产后出血、宫内感染、新生儿转新生儿重症监护室等差异无统计学意义。结论引产并未增加过期妊娠及足月胎膜早破的剖宫产率,对于产前监护条件有限的医院,可以积极处理该类产妇。需要进一步研究过期妊娠及胎膜早破临床处理的方式及时机。
Objective To systematically review and evaluate the post-term pregnancy and premature rupture of membrane as indications for induction of labor. Methods Searched databases including the Cochrane Library, PubMed, EMBASE, CBMdisc, VIP, CNKI and WANGFANG to assemble the RCT of post-term pregnancy and premature rupture of membrane. Retrieval time was October 2011. The RevManS.0 software was used for data analysis. Results For post-term pregnancy, compared with women allocated to expectant management, those who underwent labor induction had lower meconium staining rate （22.7% vs. 28.2%, OR 0.75, 95%CI 0.66-0.84, P--0.02）. Although subjects whose labor was induced experienced a lower perinatal mortality rate （0.09% vs. 0.33%, OR 0.41, 95%CI 0.77-1.18）, this difference was not statistically significant. Similarly, no significant differences were noted for NICU admission rates, meconium aspiration, or abnormal Apgar＇s score. For premature rupture of membrane, medical induction compared with expectant management, significantly increased vaginal delivery within 12 hours （RR 0.54, 95%CI 0.43-0.67, P〈0.001）. Induction of labor was not associated with an increased risk of abnormal uterine contraction and had similar risk for adverse neonatal and maternal outcomes. Conclusions Research is needed to determine risks and benefits of induction for many commonly advocated clinical indications.
出处
《循证医学》
CSCD
2012年第5期299-306,共8页
The Journal of Evidence-Based Medicine
关键词
引产
过期妊娠
足月胎膜早破
临床证据
induction of labor
post-term pregnancy
premature rupture of membrane
clinical evidence
