Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Department of Anesthesiology, Division of Women's Anesthesia, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
Can J Anaesth. 2022 Feb;69(2):216-233. doi: 10.1007/s12630-021-02142-8. Epub 2021 Nov 22.
We conducted an updated systematic review and meta-analysis on maternal outcomes associated with uterine exteriorization compared with in situ repair in women undergoing Cesarean delivery.
We searched for randomized controlled trials comparing uterine exteriorization with in situ repair during Cesarean delivery. Primary outcomes were intraoperative nausea and vomiting (IONV) and perioperative decrease in hemoglobin concentration. Secondary outcomes were postoperative nausea and vomiting (PONV), estimated blood loss, fever, endometritis, wound infection, intraoperative and postoperative pain, postoperative analgesic use, duration of surgery and hospital stay, and time to return of bowel function.
Twenty studies with 20,909 parturients were included. Exteriorization was associated with higher risk of IONV (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.66 to 2.63; I = 0%), with no difference in perioperative hemoglobin concentration decrease (mean difference, - 0.06 g·dL; 95% CI, - 0.20 to 0.08; I = 97%) compared with in situ repair. There were no significant differences in estimated blood loss, transfusion requirement, PONV, duration of surgery, duration of hospital stay, time to return of bowel function, fever, endometritis, or wound infection. Postoperative pain (incidence of pain graded > 5/10) at six hours (OR, 1.64; 95% CI, 1.31 to 2.03; I = 0%) was higher with exteriorization, but there was no difference in need for rescue analgesia (OR, 2.48; 95% CI, 0.89 to 6.90; I = 94%) or pain scores at 24 hr compared with in situ repair.
In this updated systematic review and meta-analysis, uterine exteriorization was associated with an increased risk of IONV but no significant change in perioperative hemoglobin decrease compared with in situ repair.
PROSPERO (CRD42020190074); registered 5 July 2020.
我们对与剖宫产术中子宫外置与原位修复相比相关的产妇结局进行了更新的系统评价和荟萃分析。
我们搜索了比较剖宫产术中子宫外置与原位修复的随机对照试验。主要结局是术中恶心呕吐（IONV）和围手术期血红蛋白浓度下降。次要结局是术后恶心呕吐（PONV）、估计失血量、发热、子宫内膜炎、伤口感染、术中及术后疼痛、术后镇痛使用、手术时间和住院时间以及肠道功能恢复时间。
共纳入 20 项研究，共 20909 名产妇。子宫外置与 IONV 风险增加相关（比值比 [OR]，2.09；95%置信区间 [CI]，1.66 至 2.63；I = 0%），与原位修复相比，围手术期血红蛋白浓度下降无差异（平均差值，-0.06 g·dL；95%CI，-0.20 至 0.08；I = 97%）。估计失血量、输血需求、PONV、手术时间、住院时间、肠道功能恢复时间、发热、子宫内膜炎或伤口感染无显著差异。子宫外置术后 6 小时疼痛（疼痛评分>5/10）发生率较高（OR，1.64；95%CI，1.31 至 2.03；I = 0%），但与原位修复相比，需要解救镇痛（OR，2.48；95%CI，0.89 至 6.90；I = 94%）或 24 小时疼痛评分无差异。
在本更新的系统评价和荟萃分析中，与原位修复相比，子宫外置与 IONV 风险增加相关，但围手术期血红蛋白下降无显著变化。
PROSPERO（CRD42020190074）；2020 年 7 月 5 日注册。
