Viswanathan Meera
Research Triangle Institute International, Research Triangle Park, NC 27709-2194, USA.
Paediatr Perinat Epidemiol. 2008 Jan;22 Suppl 1:10-7. doi: 10.1111/j.1365-3016.2007.00907.x.
Health care practitioners and researchers commonly call for greater reliance on evidence as a means to achieve improvement in quality of care. Systematic reviews provide a means to accelerate the use of evidence-based clinical interventions and public health practices. The extent to which these time- and resource-intensive systematic reviews currently address critical maternal health priorities in the intrapartum period is unclear. This analysis summarises key maternal health and research priorities, maps these priorities to existing reviews, identifies gaps in the literature that can be addressed with systematic reviews, and highlights key methodological concerns in conducting systematic reviews. The analysis draws on published data on maternal morbidities and an overview of 108 systematic reviews in Medline in the past 5 years using the MeSH terms 'Delivery, Obstetric,' to draw the links between health priorities, research priorities, existing evidence and missing evidence. Key causes of morbidity during labour and delivery in the United States include haemorrhage, pre-eclampsia and eclampsia, obstetric trauma and infection. Analyses of maternal morbidity and mortality suggest that key concerns include racial and ethnic disparities in health outcomes and the prevention of adverse events. Systematic reviews, however, generally tend to focus on the reduction of harms associated with interventions, are frequently limited to randomised designs, and do not address issues of health disparities. The results suggest that advances in evidence-based care in maternal health require that systematic reviews address issues of prevention of adverse events, include a larger variety of study designs when necessary and pay closer attention to health disparities.
医疗保健从业者和研究人员普遍呼吁更多地依赖证据，以此作为提高医疗质量的一种手段。系统评价提供了一种加速基于证据的临床干预措施和公共卫生实践应用的方法。目前这些耗时且耗费资源的系统评价在多大程度上解决了产时关键的孕产妇健康优先事项尚不清楚。本分析总结了关键的孕产妇健康和研究优先事项，将这些优先事项与现有评价进行映射，确定可通过系统评价解决的文献空白，并突出进行系统评价时的关键方法学问题。该分析利用已发表的孕产妇发病数据以及过去5年在Medline中使用医学主题词“产科分娩”进行的108项系统评价的概述，以梳理健康优先事项、研究优先事项、现有证据和缺失证据之间的联系。在美国，分娩期间发病的主要原因包括出血、先兆子痫和子痫、产科创伤和感染。对孕产妇发病和死亡情况的分析表明，关键问题包括健康结果方面的种族和族裔差异以及不良事件的预防。然而，系统评价通常倾向于关注减少与干预措施相关的危害，经常局限于随机设计，并且没有涉及健康差异问题。结果表明，孕产妇健康领域基于证据的护理进展要求系统评价解决不良事件的预防问题，必要时纳入更多样化的研究设计，并更密切地关注健康差异。
