Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece; First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece.
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece.
Eur J Obstet Gynecol Reprod Biol. 2019 Dec;243:150-157. doi: 10.1016/j.ejogrb.2019.10.038. Epub 2019 Nov 1.
The purpose of the present systematic review is to summarize current data concerning the impact of umbilical cord entanglement on adverse pregnancy outcomes. We used the Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases. We selected all observational (both prospective and retrospective) studies for inclusion. Meta-analysis of the risk ratios (RR) was performed with RevMan 5.3 software. Univariate meta-regression and leave-one-out meta-analysis was performed with Open Meta-Analyst statistical software. Trial sequential analysis was performed with the TSA software. Overall, twenty studies were included in the present study with 267,233 pregnant women (50.103 with cord entanglement and 217,130 controls). An increased risk of neonatal Apgar score <7 at the first minute of life was observed among cases with cord entanglement (RR = 1.75, 95% CI 1.46, 2.11). Fetal distress was significantly higher in the entanglement group (RR 1.50, 95% CI 1.33, 1.69). The incidence of fetal pH < 7.1 was also significantly higher in the entanglement group (RR 1.73, 95% CI 1.48, 2.03). Adequate power was observed in all investigated outcomes of our primary analysis after evaluating the results of the TSA analysis. Prediction intervals designated that future studies were likely to report increased risk of low Apgar score at the first minute of life, increased risk of fetal distress as well as of observing a fetal pH < 7.1. Concluding, the findings of this systematic review suggest that there is sufficient evidence to support the involvement of cord entanglement to adverse neonatal perinatal outcomes.
本系统评价的目的是总结目前关于脐带缠绕对不良妊娠结局影响的现有数据。我们使用了 Medline、Scopus、EMBASE、Cochrane 中央对照试验注册库（CENTRAL）和 Google Scholar 数据库。我们选择了所有纳入的观察性（前瞻性和回顾性）研究。使用 RevMan 5.3 软件进行风险比（RR）的荟萃分析。使用 Open Meta-Analyst 统计软件进行单变量荟萃回归和剔除一个研究的荟萃分析。使用 TSA 软件进行试验序贯分析。总体而言，本研究纳入了 20 项研究，共 267233 名孕妇（50103 名脐带缠绕，217130 名对照）。脐带缠绕的新生儿出生后 1 分钟时 Apgar 评分<7 的风险增加（RR=1.75，95%CI 1.46，2.11）。脐带缠绕组胎儿窘迫的发生率显著升高（RR 1.50，95%CI 1.33，1.69）。脐带缠绕组胎儿 pH 值<7.1 的发生率也显著升高（RR 1.73，95%CI 1.48，2.03）。在评估 TSA 分析结果后，我们对主要分析的所有研究结果进行了充分的效能分析，发现所有结果均有足够的效能。预测区间表明，未来的研究可能会报告出生后 1 分钟时 Apgar 评分较低、胎儿窘迫以及胎儿 pH 值<7.1 的风险增加。总之，本系统评价的结果表明，有足够的证据支持脐带缠绕与不良新生儿围产结局有关。
