目的:调查实际和计划交付方式之间的关联,新生儿死亡率,早产妊娠≤32周的短期结局。
方法:在三个主要数据库(PubMed,EMBASE,和Cochrane中央控制试验登记册(CENTRAL)从成立到2022年11月16日。该方案已在国际前瞻性系统审查登记册(CRD420223777870)中提前注册。
方法:符合条件的研究检查了妊娠≤32周。所有婴儿都接受了积极的护理,结局按不同的分娩方式分别报告.包括顶点和臀位的单胎和双胎妊娠。排除包括妊娠合并先兆子痫和胎盘早剥的研究。主要结局为新生儿死亡率和脑室内出血。
方法:文章按标题选择,abstract,和全文,分歧通过协商一致解决。计算基于随机效应模型的比值比和相应的95%置信区间,用于二分结果。ROBINS-I用于评估偏倚风险。
结果:本系统综述和荟萃分析共纳入19项观察性研究,涉及16,042名早产儿。实际剖宫产可提高生存率(比值比,0.62;95%置信区间,0.42至0.9),并降低脑室内出血的发生率(比值比,0.70;置信区间,0.57至0.85)与阴道分娩相比。与阴道分娩相比,计划剖宫产并不能提高极早产儿和极早产儿的生存率(优势比,0.87;95%置信区间,0.53至1.44)。子集分析发现,两个计划出生的单胎臀位早产的死亡几率显着降低(赔率比,0.56;95%置信区间,0.32至0.98)和实际(赔率比,0.34;95%置信区间,0.13至0.88)剖宫产。
结论:由于经阴道分娩的早产儿死亡率较高,因此对于妊娠≤32周的臀位早产应采用剖宫产的分娩方式。
OBJECTIVE: To investigate the association between actual and planned modes of delivery, neonatal mortality, and short-term outcomes among preterm pregnancies ≤32 weeks of gestation.
METHODS: A systematic literature search was conducted in 3 main databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to November 16, 2022. The protocol was registered in advance in the International Prospective Register of Systematic Reviews (CRD42022377870).
METHODS: Eligible studies examined pregnancies ≤32nd gestational week. All infants received active care, and the outcomes were reported separately by different modes of delivery. Singleton and twin pregnancies at vertex and
breech presentations were included. Studies that included pregnancies complicated with preeclampsia and abruptio placentae were excluded. Primary outcomes were neonatal mortality and intraventricular hemorrhage.
METHODS: Articles were selected by title, abstract, and full text, and disagreements were resolved by consensus. Random effects model-based odds ratios with corresponding 95% confidence intervals were calculated for dichotomous outcomes. Risk Of Bias In Non-randomized Studies - of Interventions-I was used to assess the risk of bias.
RESULTS: A total of 19 observational studies were included involving a total of 16,042 preterm infants in this systematic review and meta-analysis. Actual cesarean delivery improves survival (odds ratio, 0.62; 95% confidence interval, 0.42-0.9) and decreases the incidence of intraventricular hemorrhage (odds ratio, 0.70; confidence interval, 0.57-0.85) compared to vaginal delivery. Planned cesarean delivery does not improve the survival of very and extremely preterm infants compared to vaginal delivery (odds ratio, 0.87; 95% confidence interval, 0.53-1.44). Subset analysis found significantly lower odds of death for singleton
breech preterm deliveries born by both planned (odds ratio, 0.56; 95% confidence interval, 0.32-0.98) and actual (odds ratio, 0.34; 95% confidence interval, 0.13-0.88) cesarean delivery.
CONCLUSIONS: Cesarean delivery should be the mode of delivery for preterm ≤32 weeks of gestation
breech births due to the higher mortality in preterm infants born via vaginal delivery.