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Abstract：
BACKGROUND: Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in resource-limited countries in which undernutrition is common resulting in a small pelvis in which there is no easy access to functioning health facilities with a capacity to carry out operative deliveries. Therefore, this systematic review and meta-analysis aimed to estimate the incidence, causes, and maternofetal outcomes of obstructed labor among mothers who gave birth in Ethiopia.
METHODS: for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles. The search included all published and unpublished observational studies written only in the English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) was used for data analysis.
RESULTS: I included sixteen (16) primary studies with twenty-eight thousand five hundred ninety-one (28,591) mothers who gave birth in Ethiopia. The pooled incidence of obstructed labor in Ethiopia was 12.93% (95% CI: 10.44-15.42, I2 = 98.0%, p < 0.001). Out of these, 67.3% (95% CI: 33.32-101.28) did not have antenatal care follow-up, 77.86% (95% CI: 63.07-92.66) were from the rural area, and 58.52% (95% CI: 35.73- 82.31) were referred from health centers and visited hospitals after 12 h of labor. The major causes of obstructed labor were cephalo-pelvic disproportion 64.65% (95% CI: 57.15- 72.14), and malpresentation and malposition in 27.24% (95% CI: 22.05-32.42) of the cases. The commonest complications were sepsis in 38.59% (95% CI: 25.49-51.68), stillbirth in 38.08% (95% CI: 29.55-46.61), postpartum hemorrhage in 33.54% (95% CI:12.06- 55.02), uterine rupture in 29.84% (95% CI: 21.09-38.58), and maternal death in 17.27% (95% CI: 13.47-48.02) of mothers who gave birth in Ethiopia.
CONCLUSIONS: This systematic review and meta-analysis showed that the incidence of obstructed labor was high in Ethiopia. Not having antenatal care follow-up, rural residency, and visiting hospitals after 12 h of labor increased the incidence of obstructed labor. The major causes of obstructed labor were cephalo-pelvic disproportion, and malpresentation and malpresentation. Additionally, the commonest complications were sepsis, stillbirth, postpartum hemorrhage, uterine rupture, and maternal death. Thus, promoting antenatal care service utilization, a good referral system, and availing comprehensive obstetric care in nearby health institutions are recommended to prevent the incidence of obstructed labor and its complications.
METHODS: for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles. The search included all published and unpublished observational studies written only in the English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) was used for data analysis.
RESULTS: I included sixteen (16) primary studies with twenty-eight thousand five hundred ninety-one (28,591) mothers who gave birth in Ethiopia. The pooled incidence of obstructed labor in Ethiopia was 12.93% (95% CI: 10.44-15.42, I2 = 98.0%, p < 0.001). Out of these, 67.3% (95% CI: 33.32-101.28) did not have antenatal care follow-up, 77.86% (95% CI: 63.07-92.66) were from the rural area, and 58.52% (95% CI: 35.73- 82.31) were referred from health centers and visited hospitals after 12 h of labor. The major causes of obstructed labor were cephalo-pelvic disproportion 64.65% (95% CI: 57.15- 72.14), and malpresentation and malposition in 27.24% (95% CI: 22.05-32.42) of the cases. The commonest complications were sepsis in 38.59% (95% CI: 25.49-51.68), stillbirth in 38.08% (95% CI: 29.55-46.61), postpartum hemorrhage in 33.54% (95% CI:12.06- 55.02), uterine rupture in 29.84% (95% CI: 21.09-38.58), and maternal death in 17.27% (95% CI: 13.47-48.02) of mothers who gave birth in Ethiopia.
CONCLUSIONS: This systematic review and meta-analysis showed that the incidence of obstructed labor was high in Ethiopia. Not having antenatal care follow-up, rural residency, and visiting hospitals after 12 h of labor increased the incidence of obstructed labor. The major causes of obstructed labor were cephalo-pelvic disproportion, and malpresentation and malpresentation. Additionally, the commonest complications were sepsis, stillbirth, postpartum hemorrhage, uterine rupture, and maternal death. Thus, promoting antenatal care service utilization, a good referral system, and availing comprehensive obstetric care in nearby health institutions are recommended to prevent the incidence of obstructed labor and its complications.
摘要：
背景：产程梗阻是一种可预防的产科并发症。然而,在资源有限的国家，这是孕产妇死亡率和发病率以及新生儿不良后果的重要原因，在这些国家中，营养不足很普遍，导致骨盆小，无法方便地使用有能力进行手术分娩的运转良好的保健设施。因此,这项系统评价和荟萃分析旨在估计发病率，原因,以及在埃塞俄比亚分娩的母亲中难产的母胎结局。
方法：对于这篇综述，我们使用了标准的PRISMA检查表指南。不同的在线数据库用于审查：PubMed，谷歌学者，EMBASE,科克伦图书馆,Hinari,AFRO图书馆数据库，非洲在线期刊。基于适应的PICO原则，不同的搜索词被用来获得和访问必要的文章。搜索包括所有发表和未发表的观察性研究，这些研究仅以英语编写，并在埃塞俄比亚进行。MicrosoftExcel16用于数据输入，和Stata版本11.0(Stata公司，学院站,德州,美国)用于数据分析。
结果：我纳入了十六（16）项主要研究，其中有2万8千五百九十一（28,591）位在埃塞俄比亚分娩的母亲。埃塞俄比亚难产的合并发生率为12.93％（95％CI：10.44-15.42，I2=98.0％，p<0.001)。在这些中，67.3%(95%CI:33.32-101.28)没有进行产前护理随访，77.86%（95%CI：63.07-92.66）来自农村地区，58.52％（95％CI：35.73-82.31）在分娩12小时后从卫生中心转诊并到医院就诊。难产的主要原因是头盆腔不称64.65%(95%CI:57.15-72.14),27.24%(95%CI:22.05-32.42)的患者出现和错位。最常见的并发症是脓毒症，占38.59％（95％CI：25.49-51.68），38.08%的死产（95%CI：29.55-46.61），产后出血33.54%（95%CI：12.06-55.02），子宫破裂占29.84%（95%CI：21.09-38.58），在埃塞俄比亚分娩的母亲中，有17.27％（95％CI：13.47-48.02）的产妇死亡。
结论：本系统综述和荟萃分析显示，埃塞俄比亚的难产发生率很高。没有产前护理随访，农村居民，分娩12小时后去医院就诊增加了难产的发生率。难产的主要原因是头盆腔不相称，以及虚假陈述和虚假陈述。此外,最常见的并发症是败血症,死产,产后出血,子宫破裂,和产妇死亡。因此，促进产前保健服务的利用，一个好的推荐系统，并建议在附近的卫生机构进行全面的产科护理，以防止难产及其并发症的发生。
方法：对于这篇综述，我们使用了标准的PRISMA检查表指南。不同的在线数据库用于审查：PubMed，谷歌学者，EMBASE,科克伦图书馆,Hinari,AFRO图书馆数据库，非洲在线期刊。基于适应的PICO原则，不同的搜索词被用来获得和访问必要的文章。搜索包括所有发表和未发表的观察性研究，这些研究仅以英语编写，并在埃塞俄比亚进行。MicrosoftExcel16用于数据输入，和Stata版本11.0(Stata公司，学院站,德州,美国)用于数据分析。
结果：我纳入了十六（16）项主要研究，其中有2万8千五百九十一（28,591）位在埃塞俄比亚分娩的母亲。埃塞俄比亚难产的合并发生率为12.93％（95％CI：10.44-15.42，I2=98.0％，p<0.001)。在这些中，67.3%(95%CI:33.32-101.28)没有进行产前护理随访，77.86%（95%CI：63.07-92.66）来自农村地区，58.52％（95％CI：35.73-82.31）在分娩12小时后从卫生中心转诊并到医院就诊。难产的主要原因是头盆腔不称64.65%(95%CI:57.15-72.14),27.24%(95%CI:22.05-32.42)的患者出现和错位。最常见的并发症是脓毒症，占38.59％（95％CI：25.49-51.68），38.08%的死产（95%CI：29.55-46.61），产后出血33.54%（95%CI：12.06-55.02），子宫破裂占29.84%（95%CI：21.09-38.58），在埃塞俄比亚分娩的母亲中，有17.27％（95％CI：13.47-48.02）的产妇死亡。
结论：本系统综述和荟萃分析显示，埃塞俄比亚的难产发生率很高。没有产前护理随访，农村居民，分娩12小时后去医院就诊增加了难产的发生率。难产的主要原因是头盆腔不相称，以及虚假陈述和虚假陈述。此外,最常见的并发症是败血症,死产,产后出血,子宫破裂,和产妇死亡。因此，促进产前保健服务的利用，一个好的推荐系统，并建议在附近的卫生机构进行全面的产科护理，以防止难产及其并发症的发生。
