背景:这项研究的目的是对Cochrane系统评价(SRs)进行概述,以评估分娩中产妇位置的影响,以便为已解决的相关研究问题汇编现有证据。提供最新证据的简明摘要,并确定未来研究的领域。
方法:在Cochrane数据库中进行了电子搜索。两个主要结果是分娩时间和分娩时间,和手术分娩。纳入审查的质量使用AMSTAR标准进行评估,并使用GRADE标准对证据质量进行评级.
结果:我们包括3个CochraneSRs。在第一阶段的持续时间1小时22分钟(MD=-1.21;95%CI:-2.35--0.07,I2=94%)和剖宫产率的降低(RR=0.71;95%CI:0.54-0.94,I2=0%),与水平分娩相比。此外,直立组第二产程的持续时间(分钟)有统计学意义的差异(MD=-6.16;95%CI:-9.74--2.59,I2=91%),辅助阴道分娩率降低(RR=0.75,95%CI:0.66-0.86,I2=29%)。审查中的证据质量非常低至中等。
结论:目前只有有限的证据来明确评估分娩期间采取直立姿势的益处和风险。概述强调了高质量研究的必要性,包括更好地定义和全面评估分娩期间蹲下的影响。
BACKGROUND: The purpose of this study is to conduct an overview of Cochrane systematic reviews (SRs) evaluating the effects of maternal positions in childbirth in order to compile existing evidence for relevant research questions that have been addressed by more than one review, to provide a succinct summary of the up-to-date evidence and to identify areas for future research.
METHODS: An electronic search was conducted in the Cochrane database. Two primary outcomes were the duration of labor and birth, and operative birth. The quality of included reviews was assessed using the AMSTAR criteria, and the quality of the evidence was rated using the GRADE criteria.
RESULTS: We included 3 Cochrane SRs. There was a significant mean difference (MD) found in the duration of the first stage by 1 hour and 22 minutes (MD= -1.21; 95% CI: -2.35 - -0.07, I2=94%) and reduction in caesarean section rates (RR=0.71; 95% CI: 0.54-0.94, I2=0%) in the upright birth position group compared with the horizontal. Also, there was a statistically significant difference in the duration (minutes) of the second stage of labor (MD= -6.16; 95% CI: -9.74 - -2.59, I2=91%) and a reduction in assisted vaginal birth rates (RR=0.75, 95% CI: 0.66-0.86, I2=29%) in the upright group compared with the horizontal without epidural analgesia. The quality of evidence within the reviews was very low to moderate.
CONCLUSIONS: There is currently a limited body of evidence to clearly assess the benefits and risks of assuming upright positions during childbirth. The overview highlights the need for high-quality research studies, involving better definition and comprehensive assessment of the effects of squatting during childbirth.