■产后妇女可以发展创伤后应激障碍(PTSD),以应对复杂的,创伤性分娩;这些事件的患病率在美国目前仍然很高,在常规围产期护理中,没有推荐的治疗方法来预防产妇分娩相关的PTSD(CB-PTSD)并减轻其严重程度。这里,我们对现有的临床试验进行了系统评价,这些临床试验测试了CB-PTSD的预防和适应症的干预措施.
■我们对PsycInfo进行了系统评价,Psycarticles,PubMed(MEDLINE),ClinicalTrials.gov,CINAHL,ProQuest,社会学文摘,谷歌学者,Embase,WebofScience,ScienceDirect,和Scopus到2022年12月确定涉及CB-PTSD预防和治疗的临床试验。
■如果是介入性的,则包括试验,评估CB-PTSD预防策略或治疗,并报告评估CB-PTSD症状的结果。重复研究,病例报告,协议,积极的临床试验,死产后CB-PTSD的研究被排除。
■两名独立的编码人员使用修改后的Downs和Black方法学质量评估清单对试验进行了评估。通过基于Excel的表格提取样本特征和相关干预信息。
■共33项研究,包括25项随机对照试验(RCT)和8项非RCT,包括在内。试验质量从差到优不等。试验测试了心理治疗,最常作为CB-PTSD发作的二级预防(n=21);一些检查了初级(n=3)和三级(n=9)疗法。采用常规创伤聚焦疗法的早期干预措施具有积极的治疗效果,心理咨询,和母婴二重聚焦策略。治疗对有严重急性创伤应激症状或减少CB-PTSD诊断的女性的效用尚不清楚。作为三级干预是否有效。怀孕期间以教育生育计划为重点的干预措施可以改善孕产妇健康结果,但是研究仍然很少。
■一系列针对创伤性分娩的早期心理治疗,而不是普遍的,在产后头几天和几周,可能潜在地缓冲CB-PTSD的发展。而不是一种治疗适合所有人,有效的治疗应考虑个体特异性因素.AsadditionalRCTsgeneratecriticalinformationandguiderecommendationsforfirst-linepreventivetreatmentsforCB-PTSD,与创伤性分娩相关的精神后果可以减轻。
UNASSIGNED: Postpartum women can develop post-traumatic stress disorder (PTSD) in response to complicated, traumatic childbirth; prevalence of these events remains high in the U.S. Currently, there is no recommended treatment approach in routine peripartum care for preventing maternal childbirth-related PTSD (CB-PTSD) and lessening its severity. Here, we provide a systematic
review of available clinical trials testing interventions for the prevention and indication of CB-PTSD.
UNASSIGNED: We conducted a systematic
review of PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, and Scopus through December 2022 to identify clinical trials involving CB-PTSD prevention and treatment.
UNASSIGNED: Trials were included if they were interventional, evaluated CB-PTSD preventive strategies or treatments, and reported outcomes assessing CB-PTSD symptoms. Duplicate studies, case reports, protocols, active clinical trials, and studies of CB-PTSD following stillbirth were excluded.
UNASSIGNED: Two independent coders evaluated trials using a modified Downs and Black methodological quality assessment checklist. Sample characteristics and related intervention information were extracted via an Excel-based form.
UNASSIGNED: A total of 33 studies, including 25 randomized controlled trials (RCTs) and 8 non-RCTs, were included. Trial quality ranged from Poor to Excellent. Trials tested psychological therapies most often delivered as secondary prevention against CB-PTSD onset (n=21); some examined primary (n=3) and tertiary (n=9) therapies. Positive treatment effects were found for early interventions employing conventional trauma-focused therapies, psychological counseling, and mother-infant dyadic focused strategies. Therapies\' utility to aid women with severe acute traumatic stress symptoms or reduce incidence of CB-PTSD diagnosis is unclear, as is whether they are effective as tertiary intervention. Educational birth plan-focused interventions during pregnancy may improve maternal health outcomes, but studies remain scarce.
UNASSIGNED: An array of early psychological therapies delivered in response to traumatic childbirth, rather than universally, in the first postpartum days and weeks, may potentially buffer CB-PTSD development. Rather than one treatment being suitable for all, effective therapy should consider individual-specific factors. As additional RCTs generate critical information and guide recommendations for first-line preventive treatments for CB-PTSD, the psychiatric consequences associated with traumatic childbirth could be lessened.