Prophylactic antibiotics for manual removal of retained placenta in vaginal birth.

IF 8.8 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Cochrane Database of Systematic Reviews Pub Date : 2024-10-30 DOI:10.1002/14651858.CD004904.pub4
Kiattisak Kongwattanakul, Porjai Pattanittum, Apiwat Jongjakapun, Jen Sothornwit, Chetta Ngamjarus, Nampet Jampathong, Termtem Waidee, Pisake Lumbiganon
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This review aims to assess the effectiveness of prophylactic antibiotics for manual removal of retained placenta after vaginal birth.</p><p><strong>Objectives: </strong>To compare the effectiveness and adverse effects of routine prophylactic antibiotics for the manual removal of placenta after vaginal birth. To identify appropriate prophylactic antibiotic regimens.</p><p><strong>Search methods: </strong>For this update, we searched CENTRAL, MEDLINE, Embase, CINAHL, and two trials registries, in addition to screening the reference lists of retrieved studies and systematic reviews. The last search was 14 May 2024.</p><p><strong>Eligibility criteria: </strong>All randomised controlled trials and non-randomised studies comparing prophylactic antibiotics to no treatment or to another prophylactic antibiotic to prevent postpartum endometritis after manual removal of placenta after vaginal birth.</p><p><strong>Outcomes: </strong>The critical outcome in our review was postpartum endometritis. 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Studies were conducted in Germany, Bulgaria, Norway, and Israel, between 1983 and 2017.</p><p><strong>Synthesis of results: </strong>Prophylactic antibiotics versus no antibiotics was the only comparison in our analysis. Postpartum endometritis We do not know whether prophylactic antibiotics have an impact on postpartum endometritis (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.48 to 1.85; 4 studies, 974 participants; very low-certainty evidence). Postpartum haemorrhage The evidence suggests that prophylactic antibiotics may result in little to no difference in postpartum haemorrhage (RR 1.00, 95% CI 0.78 to 1.29; 1 study, 325 participants; low-certainty evidence). Neonatal intensive care unit admission (NICU) The evidence suggests that prophylactic antibiotics may result in little to no difference in NICU admission of the neonate (RR 0.86, 95% CI 0.29 to 2.61; 1 study, 353 participants; low-certainty evidence). 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引用次数: 0

Abstract

Rationale: Retained placenta is a potentially life-threatening condition because of its association with postpartum haemorrhage. Manual removal of the placenta increases the likelihood of infectious complications of the uterine cavity. So, prophylactic antibiotics are recommended by some experts, and commonly administered to reduce these risks. However, the evidence supporting this decision is limited. This review aims to assess the effectiveness of prophylactic antibiotics for manual removal of retained placenta after vaginal birth.

Objectives: To compare the effectiveness and adverse effects of routine prophylactic antibiotics for the manual removal of placenta after vaginal birth. To identify appropriate prophylactic antibiotic regimens.

Search methods: For this update, we searched CENTRAL, MEDLINE, Embase, CINAHL, and two trials registries, in addition to screening the reference lists of retrieved studies and systematic reviews. The last search was 14 May 2024.

Eligibility criteria: All randomised controlled trials and non-randomised studies comparing prophylactic antibiotics to no treatment or to another prophylactic antibiotic to prevent postpartum endometritis after manual removal of placenta after vaginal birth.

Outcomes: The critical outcome in our review was postpartum endometritis. Other important outcomes were puerperal morbidity, perineal infection, duration of hospital stay, sepsis, any infection, blood loss, postpartum haemorrhage, secondary postpartum haemorrhage, readmission to hospital, adverse effects of the drugs, women's satisfaction, and neonatal outcomes, such as jaundice, sepsis, neonatal intensive care unit admission, et cetera.

Risk of bias: The risk of bias was assessed at the outcome level. We used the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool to assess the risk of bias in non-randomised studies.

Synthesis methods: We carried out statistical analysis using Review Manager. We used a fixed-effect meta-analysis to synthesise the results, and GRADE to assess the certainty of the evidence.

Included studies: We included four retrospective cohort studies with a total of 974 participants. Studies were conducted in Germany, Bulgaria, Norway, and Israel, between 1983 and 2017.

Synthesis of results: Prophylactic antibiotics versus no antibiotics was the only comparison in our analysis. Postpartum endometritis We do not know whether prophylactic antibiotics have an impact on postpartum endometritis (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.48 to 1.85; 4 studies, 974 participants; very low-certainty evidence). Postpartum haemorrhage The evidence suggests that prophylactic antibiotics may result in little to no difference in postpartum haemorrhage (RR 1.00, 95% CI 0.78 to 1.29; 1 study, 325 participants; low-certainty evidence). Neonatal intensive care unit admission (NICU) The evidence suggests that prophylactic antibiotics may result in little to no difference in NICU admission of the neonate (RR 0.86, 95% CI 0.29 to 2.61; 1 study, 353 participants; low-certainty evidence). There were no data available for other important outcomes, including puerperal morbidity, perineal infection, duration of hospital stay, sepsis, any infection, blood loss, secondary postpartum haemorrhage, readmission to hospital, adverse effects of drugs, women's satisfaction, or neonatal outcomes of jaundice or sepsis.

Authors' conclusions: There is very uncertain evidence supporting the use of prophylactic antibiotics for manual removal of placenta for preventing postpartum endometritis. The evidence suggests that prophylactic antibiotics result in little to no difference in postpartum haemorrhage or admission to a neonatal intensive care unit. There were no available data on other important outcomes. Multicentre, randomised controlled trials comparing antibiotic prophylaxis and placebo or no antibiotic, or one antibiotic and another, for manual removal of placenta in vaginal birth are needed to provide more robust evidence.

Funding: This systematic review received support from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP).

Registration: Protocol and previous versions are available at https://10.1002/14651858.CD004904.pub3.

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在阴道分娩时,使用预防性抗生素手动清除滞留胎盘。
理由胎盘滞留与产后大出血有关,因此有可能危及生命。人工摘除胎盘会增加宫腔感染并发症的可能性。因此,一些专家建议使用预防性抗生素,并普遍使用以降低这些风险。然而,支持这一决定的证据却很有限。本综述旨在评估预防性抗生素对阴道分娩后人工清除胎盘滞留的有效性:比较阴道分娩后人工剥离胎盘时常规预防性抗生素的有效性和不良反应。确定合适的预防性抗生素方案:在本次更新中,我们检索了 CENTRAL、MEDLINE、Embase、CINAHL 和两个试验登记处,此外还筛选了检索到的研究和系统综述的参考文献列表。最后一次检索日期为 2024 年 5 月 14 日:所有随机对照试验和非随机研究,比较预防性抗生素与不治疗或另一种预防性抗生素,以预防阴道分娩后人工剥离胎盘后的产后子宫内膜炎:在我们的研究中,最重要的结果是产后子宫内膜炎。其他重要结果包括产褥期发病率、会阴部感染、住院时间、败血症、任何感染、失血、产后出血、继发性产后出血、再次入院、药物不良反应、产妇满意度以及新生儿结果,如黄疸、败血症、新生儿重症监护室入院等:偏倚风险在结果层面进行评估。我们使用非随机干预研究偏倚风险(ROBINS-I)工具来评估非随机研究的偏倚风险:我们使用综述管理器进行了统计分析。我们使用固定效应荟萃分析法对结果进行综合,并使用 GRADE 评估证据的确定性:我们纳入了四项回顾性队列研究,共有 974 人参与。研究于1983年至2017年间在德国、保加利亚、挪威和以色列进行:在我们的分析中,预防性抗生素与不使用抗生素是唯一的比较。产后子宫内膜炎 我们不知道预防性抗生素是否对产后子宫内膜炎有影响(风险比(RR)0.94,95% 置信区间(CI)0.48 至 1.85;4 项研究,974 名参与者;极低确定性证据)。产后出血 有证据表明,预防性抗生素对产后出血几乎没有影响(RR 1.00,95% CI 0.78 至 1.29;1 项研究,325 名参与者;低确定性证据)。新生儿重症监护室(NICU) 有证据表明,预防性抗生素可能导致新生儿重症监护室入院率几乎没有差异(RR 0.86,95% CI 0.29 至 2.61;1 项研究,353 名参与者;低确定性证据)。其他重要结果,包括产褥期发病率、会阴部感染、住院时间、败血症、任何感染、失血、继发性产后出血、再次入院、药物不良反应、产妇满意度、新生儿黄疸或败血症等结果,均无数据:有非常不确定的证据支持在人工剥离胎盘时使用预防性抗生素来预防产后子宫内膜炎。证据表明,预防性抗生素对产后出血或新生儿重症监护病房的收治几乎没有影响。其他重要结果方面没有可用数据。为了提供更有力的证据,需要进行多中心随机对照试验,比较抗生素预防和安慰剂或不使用抗生素,或一种抗生素和另一种抗生素,以便在阴道分娩时手动切除胎盘:本系统综述得到了联合国开发计划署-人口基金-儿童基金会-世卫组织-世界银行人类生殖研究、发展和研究培训特别计划(HRP)的支持:协议和以前的版本可在 https://10.1002/14651858.CD004904.pub3 上查阅。
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来源期刊
CiteScore
10.60
自引率
2.40%
发文量
173
审稿时长
1-2 weeks
期刊介绍: The Cochrane Database of Systematic Reviews (CDSR) stands as the premier database for systematic reviews in healthcare. It comprises Cochrane Reviews, along with protocols for these reviews, editorials, and supplements. Owned and operated by Cochrane, a worldwide independent network of healthcare stakeholders, the CDSR (ISSN 1469-493X) encompasses a broad spectrum of health-related topics, including health services.
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