Package of care for active management in labour for reducing caesarean section rates in low-risk women.
Package of care for active management in labour for reducing caesarean section rates in low-risk women.
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DOI：
10.1002/14651858.cd004907.pub2
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发表时间：
2008-10-08
影响因子：
8.4
通讯作者：
Thomas, Jane
中科院分区：
文献类型：
--
作者：
Brown, Heather C.;Paranjothy, Shantini;Dowswell, Therese;Thomas, Jane
大约15%的妇女进行了剖腹产，虽然比例各不相同，但在许多国家，这一数字正在增加。这一点令人担忧，因为更高的CS率不会带来额外的健康收益，但可能会对产妇健康产生不利影响，并对未来怀孕产生影响。积极管理劳动力已被提议作为降低CS率的一种手段。这指的是一揽子护理，包括对分娩的严格诊断、常规羊膜切开术、进展缓慢的催产素和一对一的分娩支持。确定积极的分娩管理是否降低了低风险妇女的CS发生率并提高了满意度。我们检索了Cochrane妊娠和分娩组的试验登记(2008年2月)、MEDLINE(1966至2007年12月)、EMBASE(1980至2007)、MIDIRS(1985至2007)和CINAHL(1982至2007)。随机对照试验比较了接受预定义一揽子护理(积极治疗)的低风险妇女和接受常规(可变)护理的妇女。在进入试验前被诊断为进展缓慢的试验被排除在外。至少有两位评论作者提取了数据。我们评估了包括有偏倚风险的研究。我们包括7项试验，共有5390名女性参加。研究的质量好坏参半。主动管理组CS发生率略低于常规护理组，但差异无统计学意义(RR为0.88，95%CI为0.77~1.01)。然而，在一项研究中，有大量随机化后的排除。排除这项研究后，积极管理组的CS发生率显著低于常规护理组(RR 0.77，95%CI 0.63至0.94)。积极管理组中有更多的妇女分娩时间不到12小时，但在试验期间和试验之间，分娩时间有很大差异。在镇痛剂的使用、辅助阴道分娩的比率以及母婴并发症方面，两组之间没有差异。只有一项试验调查了产妇的满意度；两组中的大多数妇女(超过75%)对护理非常满意。积极管理与CS率的小幅降低有关，但它具有高度的规范性和干预性。主动管理一揽子计划的某些组成部分可能比其他组成部分更有效。还需要进一步的工作，以确定积极管理对临产妇女的接受度。
Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one to one support in labour. To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (February 2008), MEDLINE (1966 to December 2007), EMBASE (1980 to 2007), MIDIRS (1985 to 2007) and CINAHL (1982 to 2007). Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. At least two review authors extracted data. We assessed included studies for risk of bias. We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared to the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than twelve hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups were very satisfied with care. Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.