Abstract：
BACKGROUND: There is insufficient high-quality evidence to either support or discourage water birth (WB).
OBJECTIVE: To examine different maternal complications of WB compared to standard land birth (LB). The primary outcomes were postpartum hemorrhage and genital trauma. The secondary outcome included the risk of retained placenta and shoulder dystocia.
METHODS: We searched the electronic databases including PubMed, MEDLINE, Embase, Scopus, EBSCO. In addition, we searched in Google Scholar and ClinicalTrials.gov. The pooled results were used to evaluate the association between WB and obstetric outcomes. This systematic review (SR) was reported according to PRISMA statement 2020. Statistical meta-analyses were performed using Cochrane RevMan version 5.4 software (http://www.cochrane.org).
RESULTS: This systematic review included 22 studies (20 observational studies and 2 RCT). The pooled results showed lower risk of major PPH compared to the LB group (OR = 0.76, 95% CI: 0.66-0.89), no significant difference (OR: 0.94, 95% CI: 0.50-1.78) in the incidence of minor PPH (500-1000 mL blood loss) between WB and LB, no significant difference in the rate of third- and fourth-degree lacerations (OR = 0.87, 95% CI: 0.71-1.07) and in the incidence of retained placenta (OR = 1.30, 95% CI: 0.50-3,35), fewer shoulder dystocia for WB (OR = 0.42, 95% CI: 0.35-0.50). However, compared with the LB group, the rate of first-second-degree tears in the WB group increased by 45% (OR = 1.45, 95% CI: 1.16-1.81).
CONCLUSIONS: We support ACOG guidelines recommendation for further RCT to assess the impact of water immersion during delivery on maternal outcomes.
OBJECTIVE: To examine different maternal complications of WB compared to standard land birth (LB). The primary outcomes were postpartum hemorrhage and genital trauma. The secondary outcome included the risk of retained placenta and shoulder dystocia.
METHODS: We searched the electronic databases including PubMed, MEDLINE, Embase, Scopus, EBSCO. In addition, we searched in Google Scholar and ClinicalTrials.gov. The pooled results were used to evaluate the association between WB and obstetric outcomes. This systematic review (SR) was reported according to PRISMA statement 2020. Statistical meta-analyses were performed using Cochrane RevMan version 5.4 software (http://www.cochrane.org).
RESULTS: This systematic review included 22 studies (20 observational studies and 2 RCT). The pooled results showed lower risk of major PPH compared to the LB group (OR = 0.76, 95% CI: 0.66-0.89), no significant difference (OR: 0.94, 95% CI: 0.50-1.78) in the incidence of minor PPH (500-1000 mL blood loss) between WB and LB, no significant difference in the rate of third- and fourth-degree lacerations (OR = 0.87, 95% CI: 0.71-1.07) and in the incidence of retained placenta (OR = 1.30, 95% CI: 0.50-3,35), fewer shoulder dystocia for WB (OR = 0.42, 95% CI: 0.35-0.50). However, compared with the LB group, the rate of first-second-degree tears in the WB group increased by 45% (OR = 1.45, 95% CI: 1.16-1.81).
CONCLUSIONS: We support ACOG guidelines recommendation for further RCT to assess the impact of water immersion during delivery on maternal outcomes.
摘要：
背景：没有足够的高质量证据来支持或阻止水分娩（WB）。
目的：研究与标准土地出生（LB）相比，WB的不同母体并发症。主要结局是产后出血和生殖器创伤。次要结果包括胎盘滞留和肩难产的风险。
方法：我们搜索了电子数据库，包括PubMed，MEDLINE,Embase,Scopus,EBSCO。此外,我们在GoogleScholar和ClinicalTrials.gov中搜索。合并的结果用于评估WB和产科结局之间的关联。这项系统评价(SR)是根据PRISMA2020年声明报告的。使用CochraneRevMan5.4版软件（http://www.cochrane.org)。
结果：本系统综述包括22项研究（20项观察性研究和2项RCT）。合并结果显示，与LB组相比，主要PPH的风险较低（OR=0.76，95％CI：0.66-0.89），WB和LB之间轻微PPH（500-1000mL失血）的发生率没有显着差异（OR：0.94，95％CI：0.50-1.78），三度和四度撕裂率（OR=0.87，95％CI：0.71-1.07）和保留胎盘的发生率（OR=1.30，95％CI：0.50-3,35）没有显着差异，WB的肩难产较少（OR=0.42，95％CI：0.35-0.50）。然而,与LB组相比，WB组的一二度撕裂率增加了45％（OR=1.45，95％CI：1.16-1.81）。
结论：我们支持ACOG指南建议进一步RCT，以评估分娩期间水浸对产妇结局的影响。
目的：研究与标准土地出生（LB）相比，WB的不同母体并发症。主要结局是产后出血和生殖器创伤。次要结果包括胎盘滞留和肩难产的风险。
方法：我们搜索了电子数据库，包括PubMed，MEDLINE,Embase,Scopus,EBSCO。此外,我们在GoogleScholar和ClinicalTrials.gov中搜索。合并的结果用于评估WB和产科结局之间的关联。这项系统评价(SR)是根据PRISMA2020年声明报告的。使用CochraneRevMan5.4版软件（http://www.cochrane.org)。
结果：本系统综述包括22项研究（20项观察性研究和2项RCT）。合并结果显示，与LB组相比，主要PPH的风险较低（OR=0.76，95％CI：0.66-0.89），WB和LB之间轻微PPH（500-1000mL失血）的发生率没有显着差异（OR：0.94，95％CI：0.50-1.78），三度和四度撕裂率（OR=0.87，95％CI：0.71-1.07）和保留胎盘的发生率（OR=1.30，95％CI：0.50-3,35）没有显着差异，WB的肩难产较少（OR=0.42，95％CI：0.35-0.50）。然而,与LB组相比，WB组的一二度撕裂率增加了45％（OR=1.45，95％CI：1.16-1.81）。
结论：我们支持ACOG指南建议进一步RCT，以评估分娩期间水浸对产妇结局的影响。
