Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy.
Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy.
Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:1-6. doi: 10.1016/j.ejogrb.2021.04.043. Epub 2021 May 1.
To explore maternal and perinatal outcomes of women undergoing full dilatation cesarean section (CS) who had compared to those who did not have application of fetal head elevation device (FHED).
Pubmed, Embase, Cinahl, Clinical Trial.Gov and Google Scholar databases were searched. Inclusion criteria were studies exploring maternal and perinatal outcomes in women having compared to those not having FHED at full dilatation CS. The outcomes explored were: hysterotomy to delivery time (sec), mean estimated blood loss (ml), blood loss > 1000 mL, need for blood transfusion, uterine incision extension, operative complications, need for re-operation, urinary retention, hospital re-admission, length of in hospital stay, Apgar score < 3 at 1 min, Apgar score < 7 at 5 min, neonatal arterial Ph, arterial pH < 7.1, admission to neonatal intensive care unit (NICU), neonatal sepsis, need for neonatal endotracheal intubation, neonatal death. Random effect head-to-head meta-analyses combining summary mean difference (MD), and odd ratio (OR) were used to analyze the data.
Ten studies (1326 women) were included. The mean time from hysterotomy to delivery was lower in women having compared to those not having FHED (MD: -52.26 s, 95 % CI -55.2 to -34.94, p < 0.001). Women who had FHED had also a lower mean estimated blood loss (MD: -130.82 mL, 95 % CI -130.1 to -381.0; p < 0.001) and a shorter stay in the hospital (MD: -0.884 h, 95 % CI -1.07 to -0.70; p < 0.001) compared to controls. Pregnant women having FHED at full dilatation CS had a lower risk of uterine incision extension (OR: 0.50, 95 % CI 0.3 to 0.9; p = 0.02), need for blood transfusion (OR: 0.39, 95 % CI 0.2 to 0.7; p = 0.04) and operative complications (OR: 0.44, 95 % CI 0.2 to 0.9; p = 0.03) compared to controls, while there was no difference in the other maternal outcomes between the two groups. When exploring perinatal outcome, women who received FHED had higher mean arterial pH values (MD: 0.617, 95 % CI 0.43 to 0.88; p < 0.001) and a lower risk of neonatal sepsis (OR: 0.10, 95 % CI 0.01 to 0.99; p = 0.05) and admission to NICU (OR: 0.63, 95 % CI 0.5 to 0.9; p = 0.008) compared to controls.
Application of FHED at full dilatation CS seems to be associated with improvement in some maternal and neonatal outcomes.
探讨在完全扩张剖宫产术中应用胎儿头高位装置（FHED）与未应用 FHED 的产妇和围产儿结局。
检索 Pubmed、Embase、Cinahl、Clinical Trial.Gov 和 Google Scholar 数据库。纳入标准为比较完全扩张剖宫产术中应用 FHED 与未应用 FHED 的产妇和围产儿结局的研究。探索的结局包括：切开子宫至分娩时间（秒）、平均估计失血量（毫升）、出血量>1000 毫升、需要输血、子宫切口延伸、手术并发症、需要再次手术、尿潴留、医院再入院、住院时间、1 分钟时 Apgar 评分<3、5 分钟时 Apgar 评分<7、新生儿动脉 pH 值、动脉 pH 值<7.1、入住新生儿重症监护病房（NICU）、新生儿败血症、需要新生儿气管内插管、新生儿死亡。使用合并汇总均数差（MD）和比值比（OR）的随机效应头对头荟萃分析来分析数据。
纳入了 10 项研究（1326 名妇女）。与未应用 FHED 的妇女相比，应用 FHED 的妇女从切开子宫到分娩的时间更短（MD：-52.26 秒，95%CI-55.2 至-34.94，p<0.001）。应用 FHED 的妇女的平均估计失血量也较低（MD：-130.82 毫升，95%CI-130.1 至-381.0；p<0.001），住院时间较短（MD：-0.884 小时，95%CI-1.07 至-0.70；p<0.001）。与对照组相比，完全扩张剖宫产术中应用 FHED 的孕妇子宫切口延伸的风险较低（OR：0.50，95%CI 0.3 至 0.9；p=0.02）、需要输血的风险较低（OR：0.39，95%CI 0.2 至 0.7；p=0.04）和手术并发症的风险较低（OR：0.44，95%CI 0.2 至 0.9；p=0.03），但两组产妇的其他结局无差异。当探索围产儿结局时，接受 FHED 的妇女的平均动脉 pH 值较高（MD：0.617，95%CI 0.43 至 0.88；p<0.001），新生儿败血症（OR：0.10，95%CI 0.01 至 0.99；p=0.05）和入住 NICU（OR：0.63，95%CI 0.5 至 0.9；p=0.008）的风险较低。
在完全扩张剖宫产术中应用 FHED 似乎与一些产妇和新生儿结局的改善有关。
