宫腔镜粘连松解术后患者的产科和新生儿结局的荟萃分析。
A meta-analysis of obstetric and neonatal outcomes in patients after treatment of hysteroscopic adhesiolysis.
机构信息
Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Key laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.
出版信息
Front Endocrinol (Lausanne). 2023 Mar 24;14:1126740. doi: 10.3389/fendo.2023.1126740. eCollection 2023.
INTRODUCTION
Hysteroscopic adhesiolysis is widely performed in women with intrauterine adhesions. Small observational studies have reported the obstetric and neonatal outcomes, but studies with larger sample sizes are few. The aim of this study is to evaluate the obstetric and neonatal outcomes in women after hysteroscopic adhesiolysis.
METHODS
We conducted a literature search in July 2022 using the PubMed, Embase, the Cochrane Library, and Web of Science databases, and finally, 32 studies (N = 3812) were included. We did a meta-analysis to estimate the prevalence of placenta-related disorders, including placenta previa, placental abruption, placenta accreta, placenta increta, and retained placenta. We also included other obstetric and neonatal outcomes like postpartum hemorrhage, ectopic pregnancy, oligohydramnios, gestational hypertension, gestational diabetes mellitus, and intrauterine growth restriction. The results were presented as odds ratios (ORs) with 95% confidence intervals (CIs) in studies with a control group, but otherwise as prevalence (%) with 95% confidence intervals (CIs).
RESULTS
The overall pregnancy and live birth rates were 58.97% and 45.56%, respectively. The prevalence of placenta previa differed in pregnant women who underwent hysteroscopic adhesiolysis compared with those who did not (OR, 3.27; 95% CI, 1.28-8.36). In studies without a comparative group, the pooled rate of placenta accreta was 7% (95% CI, 4-11) in 20 studies; placenta increta was 1% (95% CI, 0-4) in 5 studies; a retained placenta was 11% (95% CI, 5-24) in 5 studies; postpartum hemorrhage was 12% (95% CI, 8-18) in 12 studies; ectopic pregnancy was 1% (95% CI, 0-2) in 13 studies; oligohydramnios was 3% (95% CI, 1-6) in 3 studies; intrauterine growth restriction was 3% (95% CI, 1-8) in 3 studies; gestational hypertension was 5% (95% CI, 2-11) in 4 studies; and diabetes mellitus was 4% (95% CI, 2-7) in 3 studies.
DISCUSSION
Due to the paucity of good quality comparative data, the question of whether there is an increased prevalence of obstetric and neonatal complications in women after hysteroscopic adhesiolysis compared with the general population remains unanswered. The findings from this review will provide a basis for more well-designed studies in the future.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=364021, identifier [CRD42022364021].
简介
在患有宫腔粘连的女性中，广泛进行宫腔镜粘连松解术。一些小型观察性研究报告了产科和新生儿结局，但样本量较大的研究较少。本研究旨在评估宫腔镜粘连松解术后女性的产科和新生儿结局。
方法
我们于 2022 年 7 月在 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库中进行了文献检索，最终纳入了 32 项研究（N=3812）。我们进行了荟萃分析，以评估胎盘相关疾病的患病率，包括前置胎盘、胎盘早剥、胎盘植入、胎盘穿透和胎盘残留。我们还纳入了其他产科和新生儿结局，如产后出血、异位妊娠、羊水过少、妊娠期高血压、妊娠期糖尿病和宫内生长受限。在有对照组的研究中，结果以比值比（OR）和 95%置信区间（CI）表示，否则以患病率（%）和 95%CI 表示。
结果
总的妊娠和活产率分别为 58.97%和 45.56%。与未行宫腔镜粘连松解术的孕妇相比，行宫腔镜粘连松解术的孕妇前置胎盘的患病率不同（OR，3.27；95%CI，1.28-8.36）。在没有对照组的研究中，20 项研究中胎盘植入的总患病率为 7%（95%CI，4-11）；5 项研究中胎盘穿透的总患病率为 1%（95%CI，0-4）；5 项研究中胎盘残留的总患病率为 11%（95%CI，5-24）；12 项研究中产后出血的总患病率为 12%（95%CI，8-18）；13 项研究中异位妊娠的总患病率为 1%（95%CI，0-2）；3 项研究中羊水过少的总患病率为 3%（95%CI，1-6）；3 项研究中宫内生长受限的总患病率为 3%（95%CI，1-8）；4 项研究中妊娠期高血压的总患病率为 5%（95%CI，2-11）；3 项研究中糖尿病的总患病率为 4%（95%CI，2-7）。
讨论
由于高质量对照数据的缺乏，宫腔镜粘连松解术后女性与普通人群相比是否存在产科和新生儿并发症发生率增加的问题仍未得到解答。本综述的结果将为未来更精心设计的研究提供依据。
系统综述注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=364021，标识符[CRD42022364021]。
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