Martínez-Rodríguez Sandra, Rodríguez-Almagro Julián, Bermejo-Cantarero Alberto, Laderas-Díaz Estíbaliz, Sanchez-Millan Noelia, Hernández-Martínez Antonio
Department of Paediatrics, General Hospital of Ciudad Real, Ciudad Real, Spain; Department of Nursing, Ciudad Real School of Nursing, University of Castilla La-Mancha, Ciudad Real, Spain.
Department of Nursing, Ciudad Real School of Nursing, University of Castilla La-Mancha, Ciudad Real, Spain.
Int J Nurs Stud. 2025 Feb;162:104981. doi: 10.1016/j.ijnurstu.2024.104981. Epub 2024 Dec 12.
Postpartum haemorrhage is a preventable cause of maternal mortality that commonly occurs during the third stage of labour. Skin-to-skin contact is an intervention that can support the physiological processes of labour by increasing oxytocin levels, which can accelerate placental expulsion and enhance uterine contractions, thereby contributing to the prevention of postpartum haemorrhage.
This systematic review aims to evaluate the impact of skin-to-skin contact on key maternal variables during the third stage of labour, including the duration of this stage, placental integrity, the need for manual placental extraction, the administration of therapeutic uterotonics, and the position of the uterine fundus.
A systematic review with meta-analysis of randomised controlled trials and prospective quasi-experimental studies was conducted. Studies were searched in PubMed, Scopus, Cochrane, CINAHL, Google Scholar, and Web of Science. Statistical analysis was performed using STATA version 18. The results of the meta-analysis were reported using relative risk (RR) for dichotomous data and mean difference (MD) for continuous data, both with 95 % confidence intervals (CI). A random-effects model was employed due to the anticipated heterogeneity among the included studies. Sensitivity analyses were performed to assess the robustness of the findings, and a subgroup analysis was conducted based on the type of birth, study design, and country economic level.
Twenty-five trials were included. Skin-to-skin contact significantly reduced the duration of the third stage of labour (MD: -4.26; 95 %; CI: -5.70, -2.81), increased the likelihood of complete placental integrity (RR: 1.09; 95 % CI: 1.02, 1.16), and significantly reduced both the likelihood of a supraumbilical position of the uterine fundus (RR: 0.39; 95 % CI: 0.20, 0.76) and the need for uterotonic administration (RR: 0.24; 95 % CI: 0.12, 0.48).
Skin-to-skin contact is a simple practice that can favourably influence the physiological processes of labour and improve various maternal outcomes. These benefits include reducing the duration of the third stage of labour, ensuring complete birth of the placenta, decreasing the need for uterotonic administration, and increasing the likelihood of a proper uterine fundal position. Therefore, it is recommended to include this practice in labour care protocols.
产后出血是孕产妇死亡的一个可预防原因，通常发生在分娩第三阶段。皮肤接触是一种干预措施，可通过提高催产素水平来支持分娩的生理过程，这可以加速胎盘娩出并增强子宫收缩，从而有助于预防产后出血。
本系统评价旨在评估皮肤接触对分娩第三阶段关键孕产妇变量的影响，包括该阶段的持续时间、胎盘完整性、手动胎盘剥离的必要性、宫缩剂的使用以及子宫底的位置。
进行了一项包含随机对照试验和前瞻性准实验研究的系统评价及荟萃分析。在PubMed、Scopus、Cochrane、CINAHL、谷歌学术和科学网中检索研究。使用STATA 18版进行统计分析。荟萃分析结果采用二分数据的相对风险（RR）和连续数据的平均差（MD）报告，两者均带有95%置信区间（CI）。由于纳入研究之间预期存在异质性，采用随机效应模型。进行敏感性分析以评估结果的稳健性，并根据分娩类型、研究设计和国家经济水平进行亚组分析。
纳入25项试验。皮肤接触显著缩短了分娩第三阶段的持续时间（MD：-4.26；95%；CI：-5.70，-2.81），增加了胎盘完全完整的可能性（RR：1.09；95%CI：1.02，1.16），并显著降低了子宫底位于脐上的可能性（RR：0.39；95%CI：0.20，0.76）以及宫缩剂的使用需求（RR：0.24；95%CI：0.12，0.48）。
皮肤接触是一种简单的做法，可以对分娩的生理过程产生有利影响，并改善各种孕产妇结局。这些益处包括缩短分娩第三阶段的持续时间、确保胎盘完全娩出、减少宫缩剂的使用需求以及增加子宫底处于正确位置的可能性。因此，建议将这种做法纳入分娩护理方案。
