Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia.
BMC Womens Health. 2023 Mar 9;23(1):95. doi: 10.1186/s12905-023-02224-3.
This systematic review and meta-analysis is intended to assess the prevalence, indications, and fetal outcome of operative vaginal delivery in sub-Saharan Africa.
In this study, 17 studies with a total population of 190,900 were included in both systematic review and meta-analysis. Search for relevant articles was done by using international online databases (like Google Scholar, PubMed, HINARI, EMBASE, Web of Science, and African journals) and online repositories of Universities in Africa. The JOANNA Briggs Institute standard data extraction format was used to extract and appraise high-quality articles before being included in this study. The Cochran Q and I statistical tests were used to test the heterogeneity of the studies. The publication bias was tested by a Funnel plot and Egger's test. The overall pooled prevalence, indications, and fetal outcome of operative vaginal delivery along a 95% CI using forest plots and tables.
The overall pooled prevalence of operative vaginal delivery in sub-Saharan Africa was 7.98% (95% CI; 5.03-10.65; I2 = 99.9%, P < 0.001). The indications of operative vaginal delivery in sub-Saharan African countries include the prolonged second stage of labor 32.81%, non-reassuring fetal heart rate 37.35%, maternal exhaustion 24.81%, big baby 22.37%, maternal cardiac problems 8.75%, and preeclampsia/eclampsia 2.4%. Regarding the fetal outcome, favourable fetal outcomes were 55% (95% CI: 26.04, 84.44), p = < 0.56, I2: 99.9%). From those births with unfavourable outcomes, the need for the resuscitation of new-born was highest 28.79% followed by poor 5th minute Apgar score, NICU admission, and fresh stillbirth, 19.92, 18.8, and 3.59% respectively.
The overall prevalence of operative vaginal delivery (OVD) in sub-Saharan Africa was slightly higher compared to other countries. To reduce the increased applications and adverse fetal outcomes of OVD, capacity building for obstetrics care providers and drafting guidelines are required.
本系统评价和荟萃分析旨在评估撒哈拉以南非洲地区经阴道分娩的流行率、适应证和胎儿结局。
本研究共纳入 17 项研究，总计 190900 例人群，均进行了系统评价和荟萃分析。通过国际在线数据库（如 Google Scholar、PubMed、HINARI、EMBASE、Web of Science 和非洲期刊）和非洲大学在线知识库搜索相关文章。采用 Joanna Briggs 研究所标准数据提取格式提取和评价高质量文章，然后纳入本研究。采用 Cochran Q 和 I 统计检验检验研究的异质性。采用漏斗图和 Egger 检验检验发表偏倚。采用森林图和表格汇总经阴道分娩的总体流行率、适应证和胎儿结局，95%CI。
撒哈拉以南非洲地区经阴道分娩的总体流行率为 7.98%（95%CI：5.03-10.65；I2=99.9%，P<0.001）。撒哈拉以南非洲国家经阴道分娩的适应证包括第二产程延长 32.81%、胎心监护不典型 37.35%、产妇疲劳 24.81%、巨大儿 22.37%、产妇心脏问题 8.75%和子痫前期/子痫 2.4%。关于胎儿结局，有利的胎儿结局为 55%（95%CI：26.04, 84.44），P<0.56，I2：99.9%）。在这些不良结局的分娩中，新生儿复苏的需求最高，为 28.79%，其次是新生儿 Apgar 评分差、NICU 入院和新鲜死胎，分别为 19.92%、18.8%和 3.59%。
与其他国家相比，撒哈拉以南非洲地区经阴道分娩的总体流行率略高。为了减少经阴道分娩应用的增加和对胎儿的不利影响，需要为产科医务人员提供能力建设并制定指南。
