Saccone Gabriele, Caissutti Claudia, Ciardulli Andrea, Berghella Vincenzo
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Department of Experimental Clinical and Medical Science, DISM, Clinic of Obstetrics and Gynecology, University of Udine, Udine, Italy.
Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:64-67. doi: 10.1016/j.ejogrb.2018.02.023. Epub 2018 Feb 23.
Cesarean delivery could be complicated by postpartum hemorrhage (PPH), the first cause of maternal death.
To evaluate the efficacy of uterine massage in preventing postpartum hemorrhage at cesarean delivery.
Electronic databases from their inception until October 2017.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: We included all RCTs comparing uterine massage alone or as part of the active management of labor before or after delivery of the placenta, or both, with non-massage in the setting of cesarean delivery.
The primary outcome was PPH, defined as blood loss >1000 mL. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI).
Only 3 RCTs comparing uterine massage vs no uterine massage were found. The quality of these 3 trials in general was very low with high or unclear risk of bias. All of them included only women in the setting of spontaneous vaginal delivery and none of them included cesarean delivery, and therefore the meta-analysis was not feasible.
There is not enough evidence to determine if uterine massage prevents postpartum hemorrhage at cesarean delivery.
剖宫产可能并发产后出血（PPH），这是孕产妇死亡的首要原因。
评估子宫按摩在预防剖宫产产后出血中的效果。
自建库起至2017年10月的电子数据库。
研究入选标准、参与者及干预措施：我们纳入了所有比较单纯子宫按摩或作为胎盘娩出前或娩出后积极分娩管理一部分（或两者皆有）与剖宫产时不进行按摩的随机对照试验（RCT）。
主要结局为产后出血，定义为失血量>1000mL。采用DerSimonian和Laird随机效应模型进行Meta分析，以产生平均差（MD）或相对危险度（RR）及95%置信区间（CI）的汇总治疗效应。
仅发现3项比较子宫按摩与不进行子宫按摩的随机对照试验。这3项试验总体质量非常低，偏倚风险高或不明确。所有试验仅纳入了自然阴道分娩的女性，均未纳入剖宫产女性，因此Meta分析不可行。
尚无足够证据确定子宫按摩能否预防剖宫产产后出血。
