Dodd Jodie M, Crowther Caroline A
School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide,Australia.
Cochrane Database Syst Rev. 2012 Aug 15(8):CD005300. doi: 10.1002/14651858.CD005300.pub3.
Regular antenatal care for women with a multiple pregnancy is accepted practice, and while most women have an increase in the number of antenatal visits, there is no consensus as to what constitutes optimal care. 'Specialised' antenatal clinics have been advocated as a way of improving outcomes for women and their infants.
To assess, using the best available evidence, the benefits and harms of 'specialised' antenatal clinics compared with 'standard' antenatal care for women with a multiple pregnancy.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 April 2012).
All published, unpublished, and ongoing randomised controlled trials with reported data that compared outcomes in mothers and babies with a multiple pregnancy who received antenatal care specifically designed for women with a multiple pregnancy (as defined by the trial authors) with outcomes in controls who received 'standard' antenatal care (as defined by the trial authors).
Both review authors independently assessed trials for inclusion and trial quality. Both review authors extracted data. Data were checked for accuracy.
There were data available from one study included in the review involving 162 women with a multiple pregnancy. For the only reported primary outcome, perinatal mortality, there were no statistically significant differences identified between specialised antenatal care and standard care (risk ratio (RR) 1.02; 95% confidence interval (CI) 0.26 to 4.03). Women receiving specialised antenatal care were significantly more likely to birth by caesarean section (RR 1.38; 95% CI 1.06 to 1.81). Data was not reported in the study on the following primary outcomes: small-for-gestational age, very preterm birth or maternal death. There were no statistically significant differences identified between specialised antenatal care and standard care for other secondary outcomes examined: postnatal depression (RR 0.48; 95% CI 0.19 to 1.20), breastfeeding (RR 0.63; 95% CI 0.24 to 1.68), still birth (RR 0.68; 0.12 to 4.04) or neonatal death (RR 2.05; 95% CI 0.19 to 22.39).
AUTHORS' CONCLUSIONS: There is currently limited information available from randomised controlled trials to assess the role of 'specialised' antenatal clinics for women with a multiple pregnancy compared with 'standard' antenatal care in improving maternal and infant health outcomes. The value of 'specialised' multiple pregnancy clinics in improving health outcomes for women and their infants requires evaluation in appropriately powered and designed randomised controlled trials.
对多胎妊娠妇女进行常规产前护理是公认的做法，虽然大多数妇女的产前检查次数有所增加，但对于什么构成最佳护理尚无共识。“专科”产前诊所被倡导为改善妇女及其婴儿结局的一种方式。
利用现有最佳证据，评估与“标准”产前护理相比，“专科”产前诊所对多胎妊娠妇女的益处和危害。
我们检索了Cochrane妊娠与分娩组试验注册库（2012年4月11日）。
所有已发表、未发表和正在进行的随机对照试验，其报告的数据比较了接受专门为多胎妊娠妇女设计的产前护理（由试验作者定义）的多胎妊娠母婴结局与接受“标准”产前护理（由试验作者定义）的对照组母婴结局。
两位综述作者独立评估试验是否纳入以及试验质量。两位综述作者提取数据。检查数据的准确性。
该综述纳入的一项研究中有162名多胎妊娠妇女的数据。对于唯一报告的主要结局围产期死亡率，专科产前护理与标准护理之间未发现统计学上的显著差异（风险比（RR）1.02；95%置信区间（CI）0.26至4.03）。接受专科产前护理的妇女剖宫产分娩的可能性显著更高（RR 1.38；95%CI 1.06至1.81）。该研究未报告以下主要结局的数据：小于胎龄儿、极早产或孕产妇死亡。对于所检查的其他次要结局，专科产前护理与标准护理之间未发现统计学上的显著差异：产后抑郁（RR 0.48；95%CI 0.19至1.20）、母乳喂养（RR 0.63；95%CI 0.24至1.68）、死产（RR 0.68；0.12至4.04）或新生儿死亡（RR 2.05；95%CI 0.19至22.39）。
目前随机对照试验提供的信息有限，无法评估与“标准”产前护理相比，“专科”产前诊所对多胎妊娠妇女在改善母婴健康结局方面的作用。“专科”多胎妊娠诊所对改善妇女及其婴儿健康结局的价值需要在有足够样本量和设计合理的随机对照试验中进行评估。
