Fraser Laura Katrina, Cano-Ibáñez Naomi, Amezcua-Prieto Carmen, Khan Khalid Saeed, Lamont Ronald F, Jørgensen Jan Stener
Department of Obstetrics and Gynecology, Sygehus Sønderjylland, Aabenraa, Denmark.
Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, Odense, Denmark.
Acta Obstet Gynecol Scand. 2025 Jan;104(1):13-28. doi: 10.1111/aogs.14962. Epub 2024 Sep 15.
Obstetric violence, or mistreatment of women in obstetric care, can have severe consequences such as fear of future childbirth, post-traumatic stress disorder, and depression.
The primary objective was to estimate the prevalence of obstetric violence in high-income countries. The secondary objective was to extract the main domains of obstetric violence perceived by women from qualitative studies. Following prospective registration (PROSPERO CRD42023468570), PubMed, Web of Science, Scopus, CINAHL, Embase, and Cochrane Library were searched with no restrictions. Included studies were cross-sectional, cohort, mixed methods, and qualitative studies based on populations from high-income countries. The review was conducted by two independent reviewers. Risk of bias was assessed. Rates of obstetric violence were pooled using random effects model, computing 95% confidence intervals (CI) and assessing heterogeneity using I statistic. Funnel plots and Egger's test were used to detect potential reporting biases and small-study effects.
Of the 1821 records screened, 25 studies were included: 14 quantitative and 2 mixed methods studies, comprising 60 987 women, and 9 qualitative studies were included, comprising an additional 4356 women. 81.25% of quantitative studies, including the quantitative component of the mixed methods studies, were considered satisfactory or better regarding risk of bias. The prevalence of obstetric violence was overall 45.3% (95% CI 27.5-63.0; I = 100.0%). The prevalence of specific forms of mistreatment was also estimated. Lack of access to analgesia was 17.3% (95% CI 6.9-27.7; I = 99.7%). Ignored requests for help was 19.2% (95% CI 11.7-26.6; I = 99.0%). Shouting and scolding 19.7% (95% CI 13.0-26.4; I = 98.7%). The use of fundal pressure during the second stage of labor (Kristeller maneuver) was 30.3% (95% CI 22.1-38.5; I = 97.6%). There was no funnel asymmetry. Lack of information and/or consent were the most frequent domains extracted from the qualitative articles and the qualitative component of the mixed methods studies.
The results demonstrate that obstetric violence is a prevalent problem that women in high-income countries experience. Lack of information and/or consent were the domains most frequently described in the qualitative studies and the qualitative component of the mixed methods studies.
产科暴力，即妇女在产科护理中受到的虐待，可能会产生严重后果，如对未来分娩的恐惧、创伤后应激障碍和抑郁症。
主要目标是估计高收入国家产科暴力的患病率。次要目标是从定性研究中提取女性所感知到的产科暴力的主要领域。在进行前瞻性注册（PROSPERO CRD42023468570）后，对PubMed、科学网、Scopus、CINAHL、Embase和Cochrane图书馆进行了无限制检索。纳入的研究包括横断面研究、队列研究、混合方法研究以及基于高收入国家人群的定性研究。该综述由两名独立审稿人进行。评估了偏倚风险。使用随机效应模型汇总产科暴力发生率，计算95%置信区间（CI），并使用I统计量评估异质性。使用漏斗图和Egger检验来检测潜在的报告偏倚和小研究效应。
在筛选的1821条记录中，纳入了25项研究：14项定量研究和2项混合方法研究，共60987名女性，还纳入了9项定性研究，另有4356名女性。包括混合方法研究的定量部分在内，81.25%的定量研究在偏倚风险方面被认为令人满意或更好。产科暴力的总体患病率为45.3%（95%CI 27.5 - 63.0；I = 100.0%）。还估计了特定形式虐待的患病率。无法获得镇痛的比例为19.2%（95%CI 11.7 - 26.6；I = 99.0%）。忽视求助请求的比例为19.2%（95%CI 11.7 - 26.6；I = 99.0%）。大喊大叫和责骂的比例为19.7%（95%CI 13.0 - 26.4；I = 98.7%）。第二产程使用宫底加压（克里斯特勒手法）的比例为30.3%（95%CI 22.1 - 38.5；I = 97.6%）。没有漏斗不对称性。缺乏信息和/或同意是从定性文章以及混合方法研究的定性部分中提取的最常见领域。
结果表明，产科暴力是高收入国家女性面临的一个普遍问题。缺乏信息和/或同意是定性研究以及混合方法研究的定性部分中最常描述的领域。
