目的:产后尿潴留是妇女产后最常见的并发症之一。目的是系统评估阴道分娩后产后尿潴留的危险因素。
方法:遵循系统评价和荟萃分析的首选报告项目,我们从PubMed检索了相关研究,Embase,科克伦图书馆,WebofScience核心合集,中国全民知识互联网,王方数据库,和中国生物医学数据库进行观察性研究,调查从开始到2022年11月11日产后尿潴留的危险因素。纽卡斯尔-渥太华量表和乔安娜·布里格斯研究所的工具用于评估偏倚风险。我们使用RevMan5.3进行了荟萃分析。
结果:总计,筛选了3074篇文章,并将27项研究的数据用于荟萃分析。确定了16个危险因素,即,劳动力增加(OR=1.72,95%CI=1.17-2.51),基本奇偶校验(OR=2.36,95%CI=1.64-3.38),手动底压(OR=2.84,95%CI=1.00-8.11),会阴血肿(OR=7.28,95%CI=1.62-32.72),外阴水肿(OR=7.99,95%CI=5.50-11.63),总产程(MD=90.10,95%CI=49.11-131.08),第一产程的持续时间(MD=33.97,95%CI=10.28-57.65),第二产程的持续时间(MD=14.92,95%CI=11.79-18.05),第二产程的持续时间>60分钟(OR=3.18,95%CI=1.32-7.67),会阴侧切(OR=3.65,95%CI=1.70-7.83),严重会阴撕裂(OR=3.21,95%CI=1.84-5.61),硬膜外镇痛(OR=3.23,95%CI=1.50-6.96),产钳分娩(OR=4.95,95%CI=2.88-8.51),真空输送(OR=2.44,95%CI=1.30-4.58),新生儿出生体重>4,000g(OR=3.61,95%CI=1.96-6.65),新生儿出生体重>3,500g(OR=1.89,95%CI=1.12-3.19)。
结论:我们的结果表明,原语奇偶校验,手动眼底压力,会阴血肿,外阴水肿,劳动的总持续时间,第一个分娩阶段的持续时间,第二阶段的持续时间,第二产程的持续时间>60分钟,会阴侧切,严重的会阴撕裂,硬膜外镇痛,镊子递送,真空输送,新生儿出生体重>4,000g和>3,500g是阴道分娩妇女产后尿潴留的危险因素。需要澄清导致产后尿潴留的第一和第二阶段的具体范围。
OBJECTIVE: Postpartum urinary retention is one of the most common complications in women during the immediate postpartum period. The objective was to systematically assess risk factors for postpartum urinary retention after vaginal delivery.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we retrieved relevant studies from PubMed, Embase, Cochrane Library, Web of Science Core Collection, China National Knowledge Internet, Wangfang Database, and Chinese Biomedical Database for observational studies investigating the risk factors for postpartum urinary retention from inception to 11 November 2022. The Newcastle-Ottawa Scale and Joanna Briggs Institute\'s tool were used to assess the risk of bias. We conducted a meta-analysis using RevMan 5.3.
RESULTS: In total, 3,074 articles were screened and data from 27 studies were used in the meta-analysis. Sixteen risk factors were identified, namely, labor augmentation (OR = 1.72, 95% CI = 1.17-2.51), primiparity (OR = 2.36, 95% CI = 1.64-3.38), manual fundal pressure (OR = 2.84, 95% CI = 1.00-8.11), perineal hematoma (OR = 7.28, 95% CI = 1.62-32.72), vulvar edema (OR = 7.99, 95% CI = 5.50-11.63), the total duration of labor (MD = 90.10, 95% CI = 49.11-131.08), the duration of the first stage of labor (MD = 33.97, 95% CI = 10.28-57.65), the duration of the second stage of labor (MD = 14.92, 95% CI = 11.79-18.05), the duration of the second stage of labor > 60 min (OR = 3.18, 95% CI = 1.32-7.67), mediolateral episiotomy (OR = 3.65, 95% CI = 1.70-7.83), severe perineal tear (OR = 3.21, 95% CI = 1.84-5.61), epidural analgesia (OR = 3.23, 95% CI = 1.50-6.96), forceps delivery (OR = 4.95, 95% CI = 2.88-8.51), vacuum delivery (OR = 2.44, 95% CI = 1.30-4.58), neonatal birth weight > 4,000 g (OR = 3.61, 95% CI = 1.96-6.65), and neonatal birth weight > 3,500 g (OR = 1.89, 95% CI = 1.12-3.19).
CONCLUSIONS: Our results demonstrated that labor augmentation, primiparity, manual fundal pressure, perineal hematoma, vulvar edema, the total duration of labor, the duration of the first stage of labor, the duration of the second stage of labor, the duration of the second stage of labor > 60 min, mediolateral episiotomy, severe perineal tear, epidural analgesia, forceps delivery, vacuum delivery, and neonatal birth weight > 4,000 g and > 3,500 g were risk factors for postpartum urinary retention in women with vaginal delivery. The specific ranges of the first and the second stages of labor causing postpartum urinary retention need to be clarified.