Phillippi Julia C, Danhausen Kathleen, Alliman Jill, Phillippi R David
J Midwifery Womens Health. 2018 Jan;63(1):68-89. doi: 10.1111/jmwh.12701.
This systematic review investigates the effect of the birth center setting on neonatal mortality in economically developed countries to aid women and clinicians in decision making.
We searched the Google Scholar, CINAHL, and PubMed databases using key terms birth/birthing center or out of hospital with perinatal/neonatal outcomes. Ancestry searches identified additional studies, and an alert was set for new publications. We included primary source studies in English, published after 1980, conducted in a developed country, and researching planned birth in centers with guidelines similar to American Association of Birth Centers standards. After initial review, we conducted a preliminary analysis, assessing which measures of neonatal health, morbidity, and mortality were included across studies.
Neonatal mortality was selected as the sole summary measure as other measures were sporadically reported or inconsistently defined. Seventeen studies were included, representing at least 84,500 women admitted to a birth center in labor. There were substantial differences of study design, sampling techniques, and definitions of neonatal outcomes across studies, limiting conclusive statements of the effect of intrapartum care in a birth center. No reviewed study found a statistically increased rate of neonatal mortality in birth centers compared to low-risk women giving birth in hospitals, nor did data suggest a trend toward higher neonatal mortality in birth centers. As in all birth settings, nulliparous women, women aged greater than 35 years, and women with pregnancies of more than 42 weeks' gestation may have an increased risk of neonatal mortality.
There are substantial flaws in the literature concerning the effect of birth center care on neonatal outcomes. More research is needed on subgroups at risk of poor outcomes in the birth center environment. To expedite research, consistent use of national and international definitions of perinatal and neonatal mortality within data registries and greater detail on adverse outcomes would be beneficial.
本系统评价旨在研究在经济发达国家，分娩中心环境对新生儿死亡率的影响，以帮助女性和临床医生进行决策。
我们使用关键词“分娩/分娩中心”或“院外分娩”以及围产期/新生儿结局，在谷歌学术、CINAHL和PubMed数据库中进行检索。追溯检索确定了其他研究，并设置了新出版物提醒。我们纳入了1980年后发表的、在发达国家进行的、研究符合美国分娩中心协会标准指南的分娩中心计划分娩情况的英文原始研究。初步审查后，我们进行了初步分析，评估各项研究中纳入了哪些新生儿健康、发病率和死亡率指标。
由于其他指标报告零散或定义不一致，故选择新生儿死亡率作为唯一的汇总指标。共纳入17项研究，涉及至少84,500名进入分娩中心待产的女性。各项研究在研究设计、抽样技术和新生儿结局定义方面存在很大差异，限制了关于分娩中心产时护理效果的确切结论。没有一项综述研究发现，与在医院分娩的低风险女性相比，分娩中心的新生儿死亡率在统计学上有所增加，数据也未显示分娩中心有新生儿死亡率升高的趋势。与所有分娩环境一样，初产妇、年龄大于35岁的女性以及妊娠超过42周的女性，其新生儿死亡风险可能会增加。
关于分娩中心护理对新生儿结局影响的文献存在重大缺陷。需要对分娩中心环境中结局不佳风险较高的亚组进行更多研究。为加快研究进程，数据登记处应统一使用国家和国际围产期及新生儿死亡率定义，并更详细地记录不良结局，这将大有裨益。
