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产程活跃期后继续使用催产素与停止使用催产素的比较：一项更新的系统评价和荟萃分析。

Continued versus discontinued oxytocin after the active phase of labor: An updated systematic review and meta-analysis.

机构信息

Graduate School, Dalian Medical University, Dalian, Liaoning, China.

Department of Gynecology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning, China.

出版信息

PLoS One. 2022 May 2;17(5):e0267461. doi: 10.1371/journal.pone.0267461. eCollection 2022.

DOI:10.1371/journal.pone.0267461
PMID:35499990
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9060379/
Abstract

OBJECTIVE

To systematically assess the effect of discontinued vs continued oxytocin after active stage of labour is established.

METHODS

Pubmed, Embase, and the Cochrane Library were systematically searched to 18 April 2021. The risk ratio or mean difference with corresponding 95% confidence interval were computed to investigate the effect of intervention or control on maternal and fetus outcomes. This review was registered in the International Prospective Register of Systematic Reviews: CRD42021249635.

RESULTS

Discontinuing oxytocin when the active labour was established might decrease the risk of cesarean delivery [RR (95% CI): 0.84 (0.72-0.98), P = 0.02]. However, when we restricted our analysis to women who performed cesarean section after the active phase was reached, the difference was no longer significant [RR (95% CI): 0.82 (0.60-1.10), P = 0.19]. The incidence of uterine tachysystole [RR (95% CI): 0.36 (0.27-0.49)], postpartum hemorrhage [RR (95% CI): 0.78 (0.65-0.93)], and non-reassuring fetal heart rate [RR (95% CI): 0.66 (0.58-0.76)] were significantly lower in the oxytocin discontinuation group. We also found a possible decrease in the risk of chorioamnionitis in discontinued oxytocin group [RR (95% CI): 2.77 (1.02-5.08)]. An increased duration of active [MD (95% CI): 2.28 (2.86-41.71)] and second [MD (95% CI): 5.36 (3.18-7.54)] phase of labour was observed in discontinued oxytocin group, while the total delivery time was not significantly different [MD (95% CI): 20.17 (-24.92-65.26)].

CONCLUSION

After the active labor is reached, discontinuation of oxytocin could be considered a new recommendation for the improved maternal and fetal outcomes without delaying labour.

摘要

目的

系统评估在活跃期开始后停用催产素与继续使用催产素的效果。

方法

系统检索 PubMed、Embase 和 Cochrane Library 数据库，检索时间截至 2021 年 4 月 18 日。采用风险比或均数差值及其 95%置信区间评估干预或对照措施对母婴结局的影响。本研究已在国际前瞻性系统评价注册库（CRD42021249635）进行注册。

结果

在活跃期开始后停用催产素可能降低剖宫产率[RR（95%CI）：0.84（0.72-0.98），P=0.02]。但是，当我们将分析仅限于活跃期后行剖宫产的女性时，差异不再具有统计学意义[RR（95%CI）：0.82（0.60-1.10），P=0.19]。催产素停药组子宫收缩过频[RR（95%CI）：0.36（0.27-0.49）]、产后出血[RR（95%CI）：0.78（0.65-0.93）]和胎心监护不良[RR（95%CI）：0.66（0.58-0.76）]的发生率显著降低。我们还发现，催产素停药组绒毛膜羊膜炎的风险可能降低[RR（95%CI）：2.77（1.02-5.08）]。与继续使用催产素相比，催产素停药组活跃期[MD（95%CI）：2.28（2.86-41.71）]和第二产程[MD（95%CI）：5.36（3.18-7.54）]的持续时间更长，但总分娩时间无显著差异[MD（95%CI）：20.17（-24.92-65.26）]。

结论

活跃期开始后，停止使用催产素可能是改善母婴结局的新建议，且不会延长产程。

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Reducing neonatal morbidity by discontinuing oxytocin during the active phase of first stage of labor: a multicenter randomized controlled trial STOPOXY.通过在第一产程活跃期末停止使用催产素来降低新生儿发病率：一项多中心随机对照试验 STOPOXY。
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Births: Final Data for 2018.
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Intrapartum exposure to synthetic oxytocin, maternal BMI, and neurodevelopmental outcomes in children within the ECHO consortium.ECHO 联盟中分娩期间接触合成催产素、产妇 BMI 与儿童神经发育结局。
J Neurodev Disord. 2024 May 26;16(1):26. doi: 10.1186/s11689-024-09540-1.
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