PDF(Pubmed)
Abstract：
Directed pushing while using the Valsalva maneuver is shown to lead to bladder neck descent, especially in women with urinary incontinence (UI). There is insufficient evidence about the benefits or adverse effects between the pushing technique during the second stage of labor and urinary incontinence postpartum. The objective of this study was to evaluate the effects of the pushing technique for women during labor on postpartum UI and birth outcomes.
Scientific databases were searched for studies relating to postpartum urinary incontinence and birth outcomes when the pushing technique was used from 1986 until 2020. RCTs that assessed healthy primiparas who used the pushing technique in the second stage of labor were included. In accordance with Cochrane Handbook guidelines, risk of bias was assessed and meta-analyzed. Certainty of evidence was assessed using the GRADE approach.
Seventeen RCTs (4606 primiparas) were included. The change in UI scores from baseline to postpartum was significantly lower as a result of spontaneous pushing (two studies; 867 primiparas; standardized mean difference: SMD -0.18, 95% CI -0.31 to -0.04). Although women were in the recumbent position during the second stage, directed pushing group showed a significantly shorter labor by 21.39 min compared with the spontaneous pushing group: there was no significant difference in the duration of the second stage of labor between groups.
Primiparas who were in the upright position and who experienced spontaneous pushing during the second stage of labor could reduce their UI score from baseline to postpartum.
Scientific databases were searched for studies relating to postpartum urinary incontinence and birth outcomes when the pushing technique was used from 1986 until 2020. RCTs that assessed healthy primiparas who used the pushing technique in the second stage of labor were included. In accordance with Cochrane Handbook guidelines, risk of bias was assessed and meta-analyzed. Certainty of evidence was assessed using the GRADE approach.
Seventeen RCTs (4606 primiparas) were included. The change in UI scores from baseline to postpartum was significantly lower as a result of spontaneous pushing (two studies; 867 primiparas; standardized mean difference: SMD -0.18, 95% CI -0.31 to -0.04). Although women were in the recumbent position during the second stage, directed pushing group showed a significantly shorter labor by 21.39 min compared with the spontaneous pushing group: there was no significant difference in the duration of the second stage of labor between groups.
Primiparas who were in the upright position and who experienced spontaneous pushing during the second stage of labor could reduce their UI score from baseline to postpartum.
摘要：
显示使用Valsalva动作时的定向推动会导致膀胱颈下降，尤其是女性尿失禁（UI）。没有足够的证据证明第二产程中的推动技术与产后尿失禁之间的益处或不良反应。这项研究的目的是评估分娩期间女性的推挤技术对产后UI和分娩结局的影响。
从1986年到2020年使用推动技术时，在科学数据库中搜索与产后尿失禁和分娩结局有关的研究。纳入评估在第二分娩阶段使用推挤技术的健康初产妇的随机对照试验。根据Cochrane手册指南，我们对偏倚风险进行了评估和荟萃分析.使用等级方法评估证据的确定性。
纳入了17个随机对照试验（4606例初产妇）。由于自发推动，从基线到产后的UI评分变化显着降低（两项研究；867例初产妇；标准化平均差：SMD-0.18，95％CI-0.31至-0.04）。虽然女性在第二阶段处于卧位，与自发推动组相比，定向推动组的产程明显缩短了21.39分钟：两组之间第二产程的持续时间没有显着差异。
在第二产程中处于直立体位并经历自发推挤的初产妇可降低其从基线到产后的UI评分。
从1986年到2020年使用推动技术时，在科学数据库中搜索与产后尿失禁和分娩结局有关的研究。纳入评估在第二分娩阶段使用推挤技术的健康初产妇的随机对照试验。根据Cochrane手册指南，我们对偏倚风险进行了评估和荟萃分析.使用等级方法评估证据的确定性。
纳入了17个随机对照试验（4606例初产妇）。由于自发推动，从基线到产后的UI评分变化显着降低（两项研究；867例初产妇；标准化平均差：SMD-0.18，95％CI-0.31至-0.04）。虽然女性在第二阶段处于卧位，与自发推动组相比，定向推动组的产程明显缩短了21.39分钟：两组之间第二产程的持续时间没有显着差异。
在第二产程中处于直立体位并经历自发推挤的初产妇可降低其从基线到产后的UI评分。
