van der Wouden J C Hans, Geerdink Merle
VUmc, afd. Huisartsgeneeskunde en ouderengeneeskunde, Amsterdam.
Ned Tijdschr Geneeskd. 2013;157(46):A6847.
In the spring of 2013, the association of Dutch midwifes announced that midwifes would be offering sterile water injections for women in pain during labour. Shortly afterwards, the Dutch associations of gynaecologists and anaesthesiologists criticized this step, as the evidence for this intervention was considered insufficient. We reviewed the literature by critically appraising two recent systematic reviews. Although the overlap of included randomized trials was considerable, the reviews came to different conclusions regarding the primary outcome of one of the reviews, i.e. the proportion of unplanned caesarean sections. The order of magnitude of the effect estimated was similar, but in only one of the reviews the confidence interval encompassed 'no difference'. This discrepancy between the reviews was caused by a small difference in included trials. The results of planned and ongoing trials may reveal whether sterile water injections deserve a place in guidelines.
2013年春，荷兰助产士协会宣布，助产士将为分娩时疼痛的女性提供无菌水注射服务。不久之后，荷兰妇科医生协会和麻醉医生协会批评了这一步骤，因为该干预措施的证据被认为不充分。我们通过严格评估两项近期的系统评价来回顾文献。尽管纳入的随机试验重叠性相当大，但两项评价对于其中一项评价的主要结局，即非计划剖宫产的比例，得出了不同结论。估计的效应量级相似，但只有一项评价的置信区间包含“无差异”。两项评价之间的这种差异是由纳入试验的微小差异导致的。计划中和正在进行的试验结果可能会揭示无菌水注射是否值得在指南中占有一席之地。
