New labor management and obstetric outcomes: A systematic review and meta-analysis

Abstract

Objective: This systematic review and meta-analysis is to compare the new labor management guideline with the traditional WHO guideline with regard to obstetric outcomes. Methods: The literature search was performed in the following databases: PubMed, Embase, Web of Science, the Cochrane Library and Chinese databases (including CNKI, WanFang Database and VIP). Randomized controlled trials (RCTs) or cohort studies comparing the new labor management and the old WHO guideline in terms of maternal and neonatal morbidity in low-risk pregnant women were included. Study quality was assessed using the Cochrane Risk Bias Evaluation Tool and Newcastle-Ottawa Scale (NOS). The I2 statistic was used to evaluate heterogeneity. We used the random-effects model to pool the relative risk (RR) with corresponding 95% confidence intervals (CI). Prespecified subgroup and sensitivity analyses were conducted to explore the potential influencing factors. Publication bias analysis was also assessed based on funnel plots. Results: A total of 45 studies with a total sample size of 82,016 women were eventually included, with 15 RCTs and 30 cohort studies. 44 studies were included for data synthesis. Women with new labor management had less labor augmentation with oxytocin (RCTs: RR = 0.55 [0.36, 0.83], I2 = 47%; cohort studies: RR = 0.62 [0.55, 0.70], I2 = 58%), intrapartum cesarean section (RCTs: RR = 0.52 [0.47, 0.59], I2 = 0; cohort studies: RR = 0.61 [0.55, 0.67], I2= 75%) and operative vaginal delivery (RCTs: RR = 0.60 [0.42, 0.87], I2 = 0; cohort studies: RR = 0.69 [0.55, 0.86], I2 = 82%) without increasing the incidence of 3rd- and 4th-degree perineal laceration, postpartum hemorrhage, infectious morbidity and postpartum urine retention, fetal distress, neonatal asphyxia or neonatal intensive care unit (NICU) admission. These results were robust to sensitivity analyses. Conclusion: Our study indicates that the new labor management guideline may be more beneficial than the traditional WHO guideline, with fewer intrapartum interventions and no increase in adverse obstetric outcomes.