Abstract：
OBJECTIVE: This study aimed to evaluate if induction of labor (IOL) is associated with an increased risk of severe perineal laceration.
METHODS: A systematic search was conducted in MEDLINE, Ovid, Scopus, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, and CINHAL using a combination of keywords and text words related to \"induction of labor,\" \"severe perineal laceration,\" \"third-degree laceration,\" \"fourth-degree laceration,\" and \"OASIS\" from inception of each database until January 2023.
METHODS: We included all randomized controlled trials (RCTs) comparing IOL to expectant management of a singleton, cephalic pregnancy at term gestation that reported rates of severe perineal laceration.
UNASSIGNED: The primary outcome of interest was severe perineal laceration, defined as 3rd- or 4th-degree perineal lacerations. We conducted meta-analyses using the random effects model of DerSimonian and Laird to determine the relative risks (RR) or mean differences with 95% confidence intervals (CIs). Bias was assessed using guidelines established by Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS: A total of 11,187 unique records were screened and ultimately eight RCTs were included, involving 13,297 patients. There was no statistically significant difference in the incidence of severe perineal lacerations between the IOL and expectant management groups (209/6655 [3.1%] vs 202/6641 [3.0%]; RR 1.03, 95% CI 0.85, 1.26). There was a statistically significant decrease in the rate of cesarean birth (1090/6655 [16.4%] vs 1230/6641 [18.5%], RR 0.89, 95% CI 0.82, 0.95) and fetal macrosomia (734/2696 [27.2%] vs 964/2703 [35.7%]; RR 0.67: 95% CI 0.50, 0.90) in the IOL group.
CONCLUSIONS: There is no significant difference in the risk of severe perineal lacerations between IOL and expectant management in this meta-analysis of RCTs. Furthermore, there is a lower rate of cesarean births in the IOL group, indicating more successful vaginal deliveries with similar rates of severe perineal lacerations. Patients should be counseled that in addition to the known benefits of induction, there is no increased risk of severe perineal lacerations.
METHODS: A systematic search was conducted in MEDLINE, Ovid, Scopus, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, and CINHAL using a combination of keywords and text words related to \"induction of labor,\" \"severe perineal laceration,\" \"third-degree laceration,\" \"fourth-degree laceration,\" and \"OASIS\" from inception of each database until January 2023.
METHODS: We included all randomized controlled trials (RCTs) comparing IOL to expectant management of a singleton, cephalic pregnancy at term gestation that reported rates of severe perineal laceration.
UNASSIGNED: The primary outcome of interest was severe perineal laceration, defined as 3rd- or 4th-degree perineal lacerations. We conducted meta-analyses using the random effects model of DerSimonian and Laird to determine the relative risks (RR) or mean differences with 95% confidence intervals (CIs). Bias was assessed using guidelines established by Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS: A total of 11,187 unique records were screened and ultimately eight RCTs were included, involving 13,297 patients. There was no statistically significant difference in the incidence of severe perineal lacerations between the IOL and expectant management groups (209/6655 [3.1%] vs 202/6641 [3.0%]; RR 1.03, 95% CI 0.85, 1.26). There was a statistically significant decrease in the rate of cesarean birth (1090/6655 [16.4%] vs 1230/6641 [18.5%], RR 0.89, 95% CI 0.82, 0.95) and fetal macrosomia (734/2696 [27.2%] vs 964/2703 [35.7%]; RR 0.67: 95% CI 0.50, 0.90) in the IOL group.
CONCLUSIONS: There is no significant difference in the risk of severe perineal lacerations between IOL and expectant management in this meta-analysis of RCTs. Furthermore, there is a lower rate of cesarean births in the IOL group, indicating more successful vaginal deliveries with similar rates of severe perineal lacerations. Patients should be counseled that in addition to the known benefits of induction, there is no increased risk of severe perineal lacerations.
摘要：
目的：本研究旨在评估引产是否与严重会阴裂伤的风险增加有关。
方法：在MEDLINE中进行了系统搜索，奥维德,Scopus,ClinicalTrials.gov,Cochrane中央控制试验登记册,和CINHAL使用与“引产”相关的关键词和文本词的组合，严重会阴裂伤,\"\"三度撕裂伤,四度撕裂伤,“和”OASIS“从每个数据库开始到2023年1月。
方法：我们纳入了所有比较引产与单胎期待管理的随机对照试验，足月妊娠的头部妊娠报告了严重的会阴裂伤的发生率。
■感兴趣的主要结果是严重的会阴裂伤，定义为第三或第四度会阴撕裂。我们使用DerSimonian和Laird的随机效应模型进行了荟萃分析，以确定95％置信区间的相对风险或平均差异。使用Cochrane干预措施系统审查手册制定的指南评估偏差。
结果：共筛选了11,187条独特记录，最终纳入了8项随机对照试验，涉及13,297名患者。引产组和期待管理组会阴严重撕裂的发生率无统计学差异(209/6655(3.1%)vs.202/6641（3.0%）；相对风险（RR）1.03，95%置信区间（CI）0.85，1.26）。剖宫产率显着下降（1090/6655（16.4％）与1230/6641（18.5%），RR0.89，95%CI0.82，0.95）和胎儿巨大儿（734/2696（27.2%）与964/2703（35.7％）；引产组的RR0.67：95％CI0.50，0.90）。
结论：在这项随机对照试验的荟萃分析中，引产和期待治疗之间严重会阴撕裂的风险没有显着差异。此外，引产组的剖宫产率较低，表明阴道分娩更成功，严重会阴裂伤发生率相似。应该建议患者除了已知的诱导益处外，严重会阴撕裂的风险没有增加.
方法：在MEDLINE中进行了系统搜索，奥维德,Scopus,ClinicalTrials.gov,Cochrane中央控制试验登记册,和CINHAL使用与“引产”相关的关键词和文本词的组合，严重会阴裂伤,\"\"三度撕裂伤,四度撕裂伤,“和”OASIS“从每个数据库开始到2023年1月。
方法：我们纳入了所有比较引产与单胎期待管理的随机对照试验，足月妊娠的头部妊娠报告了严重的会阴裂伤的发生率。
■感兴趣的主要结果是严重的会阴裂伤，定义为第三或第四度会阴撕裂。我们使用DerSimonian和Laird的随机效应模型进行了荟萃分析，以确定95％置信区间的相对风险或平均差异。使用Cochrane干预措施系统审查手册制定的指南评估偏差。
结果：共筛选了11,187条独特记录，最终纳入了8项随机对照试验，涉及13,297名患者。引产组和期待管理组会阴严重撕裂的发生率无统计学差异(209/6655(3.1%)vs.202/6641（3.0%）；相对风险（RR）1.03，95%置信区间（CI）0.85，1.26）。剖宫产率显着下降（1090/6655（16.4％）与1230/6641（18.5%），RR0.89，95%CI0.82，0.95）和胎儿巨大儿（734/2696（27.2%）与964/2703（35.7％）；引产组的RR0.67：95％CI0.50，0.90）。
结论：在这项随机对照试验的荟萃分析中，引产和期待治疗之间严重会阴撕裂的风险没有显着差异。此外，引产组的剖宫产率较低，表明阴道分娩更成功，严重会阴裂伤发生率相似。应该建议患者除了已知的诱导益处外，严重会阴撕裂的风险没有增加.
