Liu Jing, Song Guang, Meng Tao, Zhao Ge
Department of Obstetrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China.
Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
Arch Gynecol Obstet. 2018 Mar;297(3):623-630. doi: 10.1007/s00404-017-4643-y. Epub 2017 Dec 29.
Membrane sweeping (MS) could increase the likelihood of spontaneous labor within 48 h. However, the rationale for performing routinely an intervention with the potential to induce labor in women with an uneventful pregnancy at 38 weeks of gestation is, at least, questionable. We conducted a meta-analysis of randomized controlled trial (RCT) studies to assess evaluated the effect of MS added to formal induction method on the spontaneous vaginal delivery, compared with formal induction alone.
PubMed, Embase, Cochrane Library databases, Web of Science, and Clinical Trials were searched from their inception to March 8, 2017. We estimate summarized relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes. The primary outcome was vaginal delivery, and second outcomes (side effects of MS) included meconium-stained liquor, admission to the neonatal unit, instrumental delivery.
Four RCTs with a total of 1377 participants were identified. The summary RR in the overall group was 1.12 (95% CI 1.05-1.18), with moderate heterogeneity (P = 0.22, I = 33%). The summary RR in the nulliparas' subgroup was 1.32 (95% CI 1.18-1.48), with no heterogeneity (P = 0.79, I = 0%). MS did not increase the risk of side effects.
MS added to formal induction significantly increased vaginal delivery rates, especially in nulliparas compared with formal induction alone. Notably, there are no obvious side effects of MS. Meanwhile, more RCTs studies are needed to investigate the side effects of MS on instrumental delivery, postpartum hemorrhage, and cervical laceration.
膜剥脱术（MS）可增加48小时内自然分娩的可能性。然而，对于妊娠38周、孕期正常的女性常规进行这种可能诱发分娩的干预措施，其合理性至少是值得怀疑的。我们进行了一项随机对照试验（RCT）研究的荟萃分析，以评估与单纯正规引产相比，在正规引产方法基础上加用MS对自然阴道分娩的影响。
检索了PubMed、Embase、Cochrane图书馆数据库、科学网和临床试验数据库，检索时间从建库至2017年3月8日。我们对二分类结局估计汇总相对风险（RR）和95%置信区间（CI）。主要结局是阴道分娩，次要结局（MS的副作用）包括羊水粪染、新生儿入住新生儿病房、器械助产。
共纳入4项RCT研究，总计1377名参与者。总体组的汇总RR为1.12（95%CI 1.05 - 1.18），异质性中等（P = 0.22，I² = 33%）。初产妇亚组的汇总RR为1.32（95%CI 1.18 - 1.48），无异质性（P = 0.79，I² = 0%）。MS未增加副作用风险。
与单纯正规引产相比，在正规引产基础上加用MS显著提高了阴道分娩率，尤其是在初产妇中。值得注意的是，MS没有明显副作用。同时，需要更多的RCT研究来调查MS对器械助产、产后出血和宫颈裂伤的副作用。
