Academic Unit of Reproductive and Developmental Medicine, Jessop Wing, University of Sheffield, Sheffield, UK.
Department of Obstetrics and Gynaecology, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
Acta Obstet Gynecol Scand. 2021 Sep;100(9):1581-1594. doi: 10.1111/aogs.14161. Epub 2021 May 13.
The cesarean section rate around the world, currently estimated at 21.1%, continues to increase. Women who undergo a cesarean section sustain a seven- to ten-fold greater risk of infective morbidity compared with those who deliver vaginally.
We aimed to assess the impact of changing gloves intraoperatively on post-cesarean section infective morbidity (PROSPERO CRD42018110529). MEDLINE, Scopus, Web of Science, CINAHL, WHO Global Index Medicus, and Cochrane Central were searched for randomized controlled trials until June 2020. Published randomized controlled trials that evaluated the effects of glove changing during cesarean section on infective complications were considered eligible for the review. Two reviewers independently selected studies, assessed the risk of bias, and extracted data about interventions and adverse maternal outcomes. Dichotomous variables were presented and included in the meta-analyses as risk ratios (RR) with 95% confidence intervals (CI). The quality of evidence was assessed using the GRADE approach in alignment with the recommendations from the Cochrane Review Group.
We identified seven randomized controlled trials reporting data over 1948 women. Changing gloves during a cesarean section was associated with a statistically significantly lower incidence of wound infective complications (RR 0.41, 95% CI 0.26-0.65, p < 0.0001; GRADE moderate quality evidence). This intervention seemed to be effective only if performed after delivery of the placenta. No significant difference was seen in the incidence of endometritis (RR 0.96, 95% CI 0.78-1.20, p = 0.74; GRADE moderate quality evidence) and/or febrile morbidity (RR 0.73, 95% CI 0.30-1.81, p = 0.50; GRADE moderate quality evidence), regardless of the timing of the intervention.
Changing gloves after delivery of the placenta during a cesarean section is associated with a significant reduction in the incidence of post-surgical wound complications compared with keeping the same gloves throughout the whole surgery. However, an adequately powered study to assess the limitations and cost-effectiveness of the intervention is needed before this recommendation can be translated into current clinical practice.
目前全球剖宫产率估计为 21.1%，仍呈上升趋势。与阴道分娩的女性相比，剖宫产的女性发生感染性发病率的风险高 7 至 10 倍。
我们旨在评估剖宫产术中更换手套对剖宫产后感染性发病率的影响（PROSPERO CRD42018110529）。我们检索了 MEDLINE、Scopus、Web of Science、CINAHL、世界卫生组织全球医学索引和 Cochrane 中心，截至 2020 年 6 月，以评估剖宫产术中更换手套对感染性并发症的影响的随机对照试验。纳入了评估剖宫产术中更换手套对感染性并发症影响的随机对照试验。两位评审员独立选择研究，评估偏倚风险，并提取干预措施和产妇不良结局的数据。二分类变量以风险比（RR）和 95%置信区间（CI）呈现，并纳入荟萃分析。证据质量使用 GRADE 方法评估，与 Cochrane 评价组的建议一致。
我们确定了 7 项随机对照试验，共报道了 1948 名女性的数据。剖宫产术中更换手套与伤口感染性并发症的发生率显著降低相关（RR 0.41，95%CI 0.26-0.65，p<0.0001；GRADE 中质量证据）。如果在胎盘娩出后进行这种干预，效果似乎更为明显。子宫内膜炎的发生率无显著差异（RR 0.96，95%CI 0.78-1.20，p=0.74；GRADE 中质量证据）和/或发热发病率（RR 0.73，95%CI 0.30-1.81，p=0.50；GRADE 中质量证据），无论干预时间如何。
与整个手术过程中使用同一副手套相比，在剖宫产术中胎盘娩出后更换手套与术后手术部位并发症发生率显著降低相关。然而，在将这一建议转化为当前的临床实践之前，需要一项足够大的研究来评估干预的局限性和成本效益。
