From the Vanderbilt Evidence-based Practice Center, Vanderbilt Institute for Medicine and Public Health, and the Department of Obstetrics and Gynecology, Vanderbilt Medical Center, Nashville, Tennessee; the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina; the Division of Neonatology, Vanderbilt Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; Eskind Biomedical Library and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
Obstet Gynecol. 2011 May;117(5):1191-1204. doi: 10.1097/AOG.0b013e318216151d.
To summarize the state of research in maternal-fetal surgery regarding the surgical repair of abnormalities in fetuses in the womb.
We searched MEDLINE from 1980 to 2010 for studies of maternal-fetal surgery for the following conditions: twin-twin transfusion syndrome, obstructive uropathy, congenital diaphragmatic hernia, myelomeningocele, thoracic lesions, cardiac malformations, and sacrococcygeal teratoma.
We used pilot-tested data collection forms to screen publications for inclusion and to extract data. We compiled information about how fetal diagnoses were defined, maternal inclusion criteria, type of surgery, study design, country, setting, comparators used, length of follow-up, outcomes measured, and adverse events.
TABULATION, INTEGRATION, AND RESULTS: Two reviewers independently extracted data and discordance was resolved by a third party. Of 1,341 articles located, we retained 258 (comprising 166 unique study populations). Three studies were randomized controlled trials; the majority of the evidence was observational (116 case series [70%], 36 retrospective [22%], and 11 prospective [7%] cohorts). Twin-twin transfusion is the most studied condition, with 84 studies including 2,532 pregnancies. Fewer than 500 pregnancies are represented in the literature for each of the other conditions except congenital diaphragmatic hernia (n=503). Inclusion criteria were poorly specified. Outcomes typically measured were survival to birth, preterm birth, and neonatal death. Longer-term outcomes were sparse but included pulmonary, renal, and neurologic status and developmental milestones. Maternal outcome data were rare.
Although developing rapidly, maternal-fetal surgery research has yet to achieve the typical quality of studies and aggregate strength of evidence needed to optimally inform care.
总结胎儿内畸形的母胎手术研究现状。
我们检索了 1980 年至 2010 年的 MEDLINE 数据库，以获取以下条件的母胎手术研究：双胎输血综合征、梗阻性尿路病、先天性膈疝、脊髓脊膜膨出、胸壁病变、心脏畸形和骶尾部畸胎瘤。
我们使用经过试验的预筛选数据收集表来筛选出版物以纳入和提取数据。我们汇总了有关胎儿诊断如何定义、产妇纳入标准、手术类型、研究设计、国家、地点、使用的对照、随访时间、测量的结果和不良事件的信息。
列表、整合和结果：两位评审员独立提取数据，分歧由第三方解决。在定位的 1341 篇文章中，我们保留了 258 篇（包含 166 个独特的研究人群）。有 3 项研究为随机对照试验；大多数证据为观察性（70%的 116 项病例系列研究，22%的 36 项回顾性研究，7%的 11 项前瞻性队列研究）。双胎输血综合征是研究最多的疾病，有 84 项研究包括 2532 例妊娠。除先天性膈疝（n=503）外，其他每种疾病的文献中代表的妊娠数均少于 500 例。纳入标准规定得很差。通常测量的结果是存活至分娩、早产和新生儿死亡。更长期的结果较为稀少，但包括肺部、肾脏和神经系统状态以及发育里程碑。产妇结局数据很少。
尽管发展迅速，但母胎手术研究尚未达到最佳告知护理所需的研究质量和证据综合强度。
