{"title":"助产士领导下的剖腹产后阴道分娩（VBAC）妇女的分娩结果：系统回顾和荟萃分析。","authors":"Elidh Parslow , Hannah Rayment-Jones","doi":"10.1016/j.midw.2024.104168","DOIUrl":null,"url":null,"abstract":"<div><h3>Problem</h3><p>There is a limited knowledge base available to midwives, obstetricians and women planning vaginal birth after caesarean (VBAC), impeding their ability to make informed choices regarding planned place of birth.</p></div><div><h3>Background</h3><p>A VBAC is associated with fewer complications for both mother and baby, but little is known on the safety and success of planning a VBAC in midwifery led settings such as birth centres and home birth, compared to obstetric led settings.</p></div><div><h3>Aim</h3><p>To synthesise the findings of published studies regarding maternal and neonatal outcomes with planned VBAC in midwifery setting compared to obstetric units.</p></div><div><h3>Methods</h3><p>PubMed, EMBASE, CINAHL complete, Maternity and Infant Care, PsycINFO, and Science Citation Index databases were systematically searched on 16/08/2022 for all quantitative research on the outcomes for women planning VBAC in midwifery led settings compared to obstetric led settings in high income countries. Included studies were quality assessed using the CASP Checklist. Binary outcomes are incorporated into pairwise meta-analyses, effect sizes reported as risk ratios with 95 % confidence intervals. A τ² estimate of between-study variance was performed for each binary outcome analysis. Other, more heterogeneous outcomes are narratively reported.</p></div><div><h3>Findings</h3><p>Two high-quality studies, out of 420 articles, were included. VBAC planned in a midwifery-led setting was associated with a statistically significant increase in unassisted vaginal birth (RR=1.42 95 % CI 1.37 to 1.48) and decrease in emergency caesarean section (RR= 0.46 95 % CI 0.39 to 0.56) and instrumental birth (RR= 0.33 95 % CI 0.23 to 0.47) compared with planned VBAC in an obstetric setting. There were no significant differences in uterine rupture (RR= 1.03 95 % CI 0.52 to 2.07), admission to special care nursery (RR= 0.71 95 % CI 0.47 to 1.23) or Apgar score of 7 or less at 5 min (RR= 1.16 95 % CI 0.66 to 2.03).</p></div><div><h3>Conclusion</h3><p>Planning VBAC in midwifery led settings is associated with increased vaginal birth and a reduction in interventions such as instrumental birth and caesarean section. Adverse perinatal outcomes are rare, and further research is required to draw conclusions on these risks.</p></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"139 ","pages":"Article 104168"},"PeriodicalIF":2.6000,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0266613824002511/pdfft?md5=7a2a60bb9bd2a2f283401ee7fcb7c83a&pid=1-s2.0-S0266613824002511-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Birth outcomes for women planning Vaginal Birth after Caesarean (VBAC) in midwifery led settings: A systematic review and meta-analysis\",\"authors\":\"Elidh Parslow , Hannah Rayment-Jones\",\"doi\":\"10.1016/j.midw.2024.104168\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Problem</h3><p>There is a limited knowledge base available to midwives, obstetricians and women planning vaginal birth after caesarean (VBAC), impeding their ability to make informed choices regarding planned place of birth.</p></div><div><h3>Background</h3><p>A VBAC is associated with fewer complications for both mother and baby, but little is known on the safety and success of planning a VBAC in midwifery led settings such as birth centres and home birth, compared to obstetric led settings.</p></div><div><h3>Aim</h3><p>To synthesise the findings of published studies regarding maternal and neonatal outcomes with planned VBAC in midwifery setting compared to obstetric units.</p></div><div><h3>Methods</h3><p>PubMed, EMBASE, CINAHL complete, Maternity and Infant Care, PsycINFO, and Science Citation Index databases were systematically searched on 16/08/2022 for all quantitative research on the outcomes for women planning VBAC in midwifery led settings compared to obstetric led settings in high income countries. Included studies were quality assessed using the CASP Checklist. Binary outcomes are incorporated into pairwise meta-analyses, effect sizes reported as risk ratios with 95 % confidence intervals. A τ² estimate of between-study variance was performed for each binary outcome analysis. Other, more heterogeneous outcomes are narratively reported.</p></div><div><h3>Findings</h3><p>Two high-quality studies, out of 420 articles, were included. VBAC planned in a midwifery-led setting was associated with a statistically significant increase in unassisted vaginal birth (RR=1.42 95 % CI 1.37 to 1.48) and decrease in emergency caesarean section (RR= 0.46 95 % CI 0.39 to 0.56) and instrumental birth (RR= 0.33 95 % CI 0.23 to 0.47) compared with planned VBAC in an obstetric setting. There were no significant differences in uterine rupture (RR= 1.03 95 % CI 0.52 to 2.07), admission to special care nursery (RR= 0.71 95 % CI 0.47 to 1.23) or Apgar score of 7 or less at 5 min (RR= 1.16 95 % CI 0.66 to 2.03).</p></div><div><h3>Conclusion</h3><p>Planning VBAC in midwifery led settings is associated with increased vaginal birth and a reduction in interventions such as instrumental birth and caesarean section. Adverse perinatal outcomes are rare, and further research is required to draw conclusions on these risks.</p></div>\",\"PeriodicalId\":18495,\"journal\":{\"name\":\"Midwifery\",\"volume\":\"139 \",\"pages\":\"Article 104168\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-08-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0266613824002511/pdfft?md5=7a2a60bb9bd2a2f283401ee7fcb7c83a&pid=1-s2.0-S0266613824002511-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Midwifery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0266613824002511\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Midwifery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0266613824002511","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 0
摘要
问题：助产士、产科医生和计划剖腹产后经阴道分娩（VBAC）的妇女所掌握的知识有限，这妨碍了她们对计划分娩地点做出明智选择的能力：VBAC对母亲和婴儿的并发症都较少，但与产科相比，助产士主导的分娩中心和家庭分娩等环境下计划VBAC的安全性和成功率却鲜为人知。目的：综合已发表的关于助产士与产科相比计划VBAC的产妇和新生儿结局的研究结果：方法：于 2022 年 8 月 16 日在 PubMed、EMBASE、CINAHL complete、Maternity and Infant Care、PsycINFO 和 Science Citation Index 数据库中系统检索了所有关于高收入国家助产机构与产科机构中计划 VBAC 的产妇预后的定量研究。采用 CASP 检查表对纳入的研究进行了质量评估。二元结果被纳入成对荟萃分析，效应大小以风险比和 95 % 置信区间报告。对每项二元结果分析都进行了研究间方差τ²估计。其他更多的异质性结果以叙述的方式进行了报告：在 420 篇文章中，共纳入了两项高质量的研究。与在产科环境中计划 VBAC 相比，在助产士主导的环境中计划 VBAC 与无助产阴道分娩（RR=1.42 95 % CI 1.37 至 1.48）显著增加、紧急剖腹产（RR=0.46 95 % CI 0.39 至 0.56）和器械助产（RR=0.33 95 % CI 0.23 至 0.47）显著减少有关。在子宫破裂（RR= 1.03 95 % CI 0.52 至 2.07）、入住特殊护理育婴室（RR= 0.71 95 % CI 0.47 至 1.23）或 5 分钟内阿普加评分 7 分或以下（RR= 1.16 95 % CI 0.66 至 2.03）方面没有明显差异：在助产士主导的情况下，计划 VBAC 与增加阴道分娩以及减少器械助产和剖腹产等干预措施有关。不利的围产期结果并不多见，需要进一步研究才能就这些风险得出结论。
Birth outcomes for women planning Vaginal Birth after Caesarean (VBAC) in midwifery led settings: A systematic review and meta-analysis
Problem
There is a limited knowledge base available to midwives, obstetricians and women planning vaginal birth after caesarean (VBAC), impeding their ability to make informed choices regarding planned place of birth.
Background
A VBAC is associated with fewer complications for both mother and baby, but little is known on the safety and success of planning a VBAC in midwifery led settings such as birth centres and home birth, compared to obstetric led settings.
Aim
To synthesise the findings of published studies regarding maternal and neonatal outcomes with planned VBAC in midwifery setting compared to obstetric units.
Methods
PubMed, EMBASE, CINAHL complete, Maternity and Infant Care, PsycINFO, and Science Citation Index databases were systematically searched on 16/08/2022 for all quantitative research on the outcomes for women planning VBAC in midwifery led settings compared to obstetric led settings in high income countries. Included studies were quality assessed using the CASP Checklist. Binary outcomes are incorporated into pairwise meta-analyses, effect sizes reported as risk ratios with 95 % confidence intervals. A τ² estimate of between-study variance was performed for each binary outcome analysis. Other, more heterogeneous outcomes are narratively reported.
Findings
Two high-quality studies, out of 420 articles, were included. VBAC planned in a midwifery-led setting was associated with a statistically significant increase in unassisted vaginal birth (RR=1.42 95 % CI 1.37 to 1.48) and decrease in emergency caesarean section (RR= 0.46 95 % CI 0.39 to 0.56) and instrumental birth (RR= 0.33 95 % CI 0.23 to 0.47) compared with planned VBAC in an obstetric setting. There were no significant differences in uterine rupture (RR= 1.03 95 % CI 0.52 to 2.07), admission to special care nursery (RR= 0.71 95 % CI 0.47 to 1.23) or Apgar score of 7 or less at 5 min (RR= 1.16 95 % CI 0.66 to 2.03).
Conclusion
Planning VBAC in midwifery led settings is associated with increased vaginal birth and a reduction in interventions such as instrumental birth and caesarean section. Adverse perinatal outcomes are rare, and further research is required to draw conclusions on these risks.
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