Meng-Chang Yang, Peng Li, Wen-Jie Su, Rong Jiang, Jia Deng, Ru-Rong Wang, Chao-Li Huang
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The random-effects model or fixed-effects model were used to calculate the pooled effect for the included studies according to heterogeneity. And the term of standardized mean difference (SMD) with 95% confidence intervals (CI) was pooled and estimated the effects across all studies.</p><p><strong>Results: </strong>A total of nine RCTs were included in this meta-analysis. Compared with spontaneous group, manual placental removal increased the amount of hemorrhage (<i>SMD</i> = 0.53, 95% CI [0.12, 0.94]; <i>Z</i> = 2.54, <i>P</i> = 0.011) and increased the risk of endometritis (<i>OR</i> = 1.84, 95% CI [1.31, 2.58]; <i>Z</i> = 3.52, <i>P</i> < 0.0001). In contrast, there was no significant difference concerning the operating time (<i>SMD</i> = -0.30, 95% CI [-0.85, 0.24]; <i>Z</i> = 1.09, <i>P</i> = 0.276), the length of hospital stays (<i>SMD</i> = 0.11, 95% CI [-0.08, 0.30]; <i>Z</i> = 1.11, <i>P</i> = 0.265), and blood transfusion requirement (<i>OR</i> = 1.36, 95% CI [0.91, 2.04]; Z = 1.52, <i>P</i> = 0.129), respectively.</p><p><strong>Conclusion: </strong>Comparing with spontaneous placental removal, manual placental removal appeared to be less positive effect during CS. Because of the limitations of this meta-analysis, more high-quality RCTs are needed to confirm our findings.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":" ","pages":"1283-1293"},"PeriodicalIF":2.8000,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/c0/tcrm-17-1283.PMC8648276.pdf","citationCount":"2","resultStr":"{\"title\":\"Manual Removal versus Spontaneous Delivery of the Placenta at Cesarean Section: A Meta-Analysis of Randomized Controlled Trials.\",\"authors\":\"Meng-Chang Yang, Peng Li, Wen-Jie Su, Rong Jiang, Jia Deng, Ru-Rong Wang, Chao-Li Huang\",\"doi\":\"10.2147/TCRM.S333557\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Several randomized clinical trials (RCTs) investigated the effects of the manual placental removal on hemorrhage or other hemorrhage-related complications compared with the spontaneous placental removal during cesarean section (CS), while the results remained controversial and were inconsistent. The purpose of this meta-analysis was to quantify the pooled effects of the methods of placental removal on hemorrhage during CS.</p><p><strong>Patients and methods: </strong>A systematic literature search was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Heterogeneity was tested by <i>I</i> <sup>2</sup> statistics and Q-statistic. The random-effects model or fixed-effects model were used to calculate the pooled effect for the included studies according to heterogeneity. And the term of standardized mean difference (SMD) with 95% confidence intervals (CI) was pooled and estimated the effects across all studies.</p><p><strong>Results: </strong>A total of nine RCTs were included in this meta-analysis. Compared with spontaneous group, manual placental removal increased the amount of hemorrhage (<i>SMD</i> = 0.53, 95% CI [0.12, 0.94]; <i>Z</i> = 2.54, <i>P</i> = 0.011) and increased the risk of endometritis (<i>OR</i> = 1.84, 95% CI [1.31, 2.58]; <i>Z</i> = 3.52, <i>P</i> < 0.0001). In contrast, there was no significant difference concerning the operating time (<i>SMD</i> = -0.30, 95% CI [-0.85, 0.24]; <i>Z</i> = 1.09, <i>P</i> = 0.276), the length of hospital stays (<i>SMD</i> = 0.11, 95% CI [-0.08, 0.30]; <i>Z</i> = 1.11, <i>P</i> = 0.265), and blood transfusion requirement (<i>OR</i> = 1.36, 95% CI [0.91, 2.04]; Z = 1.52, <i>P</i> = 0.129), respectively.</p><p><strong>Conclusion: </strong>Comparing with spontaneous placental removal, manual placental removal appeared to be less positive effect during CS. Because of the limitations of this meta-analysis, more high-quality RCTs are needed to confirm our findings.</p>\",\"PeriodicalId\":22977,\"journal\":{\"name\":\"Therapeutics and Clinical Risk Management\",\"volume\":\" \",\"pages\":\"1283-1293\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2021-12-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/c0/tcrm-17-1283.PMC8648276.pdf\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutics and Clinical Risk Management\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/TCRM.S333557\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"Pharmacology, Toxicology and Pharmaceutics\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutics and Clinical Risk Management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/TCRM.S333557","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Pharmacology, Toxicology and Pharmaceutics","Score":null,"Total":0}
引用次数: 2
摘要
目的:几项随机临床试验(RCTs)比较了剖宫产术(CS)中人工胎盘摘除与自然胎盘摘除对出血或其他出血相关并发症的影响，但结果仍存在争议和不一致。本荟萃分析的目的是量化胎盘切除方法对CS期间出血的综合影响。患者和方法:使用PubMed、EMBASE、Web of Science和Google Scholar进行系统的文献检索。采用I 2统计量和q统计量检验异质性。根据异质性，采用随机效应模型或固定效应模型计算纳入研究的合并效应。95%置信区间(CI)的标准化平均差(SMD)项进行汇总并估计所有研究的效果。结果:本meta分析共纳入9项rct。与自发组比较，人工取胎盘使出血量增加(SMD = 0.53, 95% CI [0.12, 0.94];Z = 2.54, P = 0.011)，子宫内膜炎风险增加(OR = 1.84, 95% CI [1.31, 2.58];Z = 3.52, p < 0.0001)。相比之下，两组在手术时间上无显著差异(SMD = -0.30, 95% CI [-0.85, 0.24];Z = 1.09, P = 0.276)、住院时间(SMD = 0.11, 95% CI [-0.08, 0.30];Z = 1.11, P = 0.265)，输血需要量(OR = 1.36, 95% CI [0.91, 2.04];Z = 1.52, P = 0.129)。结论:人工胎盘摘除术与自然胎盘摘除术相比效果较差。由于本荟萃分析的局限性，需要更多高质量的随机对照试验来证实我们的发现。
Manual Removal versus Spontaneous Delivery of the Placenta at Cesarean Section: A Meta-Analysis of Randomized Controlled Trials.
Purpose: Several randomized clinical trials (RCTs) investigated the effects of the manual placental removal on hemorrhage or other hemorrhage-related complications compared with the spontaneous placental removal during cesarean section (CS), while the results remained controversial and were inconsistent. The purpose of this meta-analysis was to quantify the pooled effects of the methods of placental removal on hemorrhage during CS.
Patients and methods: A systematic literature search was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Heterogeneity was tested by I2 statistics and Q-statistic. The random-effects model or fixed-effects model were used to calculate the pooled effect for the included studies according to heterogeneity. And the term of standardized mean difference (SMD) with 95% confidence intervals (CI) was pooled and estimated the effects across all studies.
Results: A total of nine RCTs were included in this meta-analysis. Compared with spontaneous group, manual placental removal increased the amount of hemorrhage (SMD = 0.53, 95% CI [0.12, 0.94]; Z = 2.54, P = 0.011) and increased the risk of endometritis (OR = 1.84, 95% CI [1.31, 2.58]; Z = 3.52, P < 0.0001). In contrast, there was no significant difference concerning the operating time (SMD = -0.30, 95% CI [-0.85, 0.24]; Z = 1.09, P = 0.276), the length of hospital stays (SMD = 0.11, 95% CI [-0.08, 0.30]; Z = 1.11, P = 0.265), and blood transfusion requirement (OR = 1.36, 95% CI [0.91, 2.04]; Z = 1.52, P = 0.129), respectively.
Conclusion: Comparing with spontaneous placental removal, manual placental removal appeared to be less positive effect during CS. Because of the limitations of this meta-analysis, more high-quality RCTs are needed to confirm our findings.
期刊介绍：
Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas.
The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature.
As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication.
The journal does not accept study protocols, animal-based or cell line-based studies.
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