摘要
目的系统评价双胎孕妇中孕期使用子宫颈托预防双胎妊娠发生早产的有效性。方法计算机检索相关文献数据库中,关于双胎孕妇中孕期使用子宫颈托预防双胎妊娠发生早产的相关文献。其中,英文数据库包括:Embase、PubMed、Cochrane Central Register of Controlled Trials (CCRT)、Cochrane Database of Systematic Reviews、Ovid-Medline及 American College of Physicians (ACP)等;中文数据库包括:中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普(VIP)和万方数据库。此外,手工检索相关会议资料、论文集及学位论文汇编等。检索时间设定为自数据库建库至2018年1月,检索内容为双胎孕妇中孕期使用子宫颈托预防双胎妊娠发生早产的随机对照试验(RCT)。采用Cochrane系统评价法,对检索文献进行质量评价和Meta分析,参照系统综述和Meta分析优先报告的条目(PRISMA)报告规范进行报告。各研究间的异质性采用 I 2检验,若 I 2≤ 50%,则采用固定效应模型Meta分析;若 I 2>50%,则采用随机效应模型Meta分析。采用Mantel-Haenszel法评估 RR 值及其95% CI 。结果①通过相关文献检索,共计5篇RCT文献符合本研究纳入标准与排除标准,涉及2 465例双胎妊娠孕妇,其中宫颈长度(CL)缩短双胎妊娠孕妇为827例。②对纳入文献的方法学质量评价结果显示,纳入文献质量为中等质量文献。③对纳入的双胎孕妇中孕期使用子宫颈托的双胎妊娠预防早产主要/次要指标的Meta分析结果示,中孕期使用子宫颈托,可明显降低中孕期双胎妊娠者分娩新生儿的新生儿重症监护病房(NICU)治疗率( RR =0.73,95% CI :0.53~1.00, P =0.05),但是增加了双胎孕妇的阴道排液发生率( RR =3.07,95% CI :1.29~7.30, P =0.01)和早产儿视网膜病变(ROP)发生率( RR =3.85,95% CI :1.19~12.45, P =0.02)。对中孕期双胎妊娠合并CL缩短孕妇的亚组Meta分析结果显示,中孕期CL<38 mm双胎妊娠孕妇使用子宫�
Objective To evaluate the efficacy and safety of cervical pessaries in the prevention of preterm birth in twin pregnancy with short cervical length (CL). Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid-Medline, American College of Physicians (ACP), China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases for randomized controlled trial (RCT) to evaluate efficacy and safety of cervical pessaries in the prevention of preterm birth in twin pregnancy with short CL from the date of database inception to January 2018. Related conference papers and dissertations were also searched manually. The methodological quality and data extraction of the included studies were assessed independently by two reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analysis was conducted using RevMan 5.0 software. The heterogeneity of the treatment was evaluated with the I 2 statistic. RR value and its 95% CI were computed for dichotomous data and were combined with a fixed-effects model ( I 2< 50%) using the Mantel-Haenszel method. A random-effects model was used to analyze the results (with values of I 2>50%). Results Five RCTs, involving 2 465 twin pregnancies and 827 of them combined with short CL that pertained to pessary use, met the inclusion criteria. Treatment with a pessary was associated with a significant reduction in the rate of admission to the neonatal intensive care unit (NICU)( RR =0.73, 95% CI : 0.53-1.00, P =0.05). There were higher incidences of vaginal discharge ( RR =3.07, 95% CI : 1.29-7.30, P =0.01) and retinopathy of prematurity(ROP)( RR =3.85, 95% CI: 1.19-12.45, P =0.02) in cervical pessary group. No significant differences were found between pessary group and control group among other major maternal and neonatal outcomes. A subgroup analysis of twin pregnanc
作者
徐婷婷
周芷伊
刘娜
邓春燕
黄桂琼
王晓东
余海燕
Xu Tingting;Zhou Zhiyi;Liu Na;Deng Chunyan;Huang Guiqiong;Wang Xiaodong;Yu Haiyan(Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseasesof Women and Children (Sichuan University),Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2019年第3期253-261,共9页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
四川省科技厅重点研发项目(2018FZ0041)
四川省学术和技术带头人培养支持经费项目(川人社办发[2017]919-25)~~
关键词
子宫托
子宫颈
妊娠中期
双胎妊娠
宫颈长度测量
系统评价
妊娠结局
孕妇
Pessaries
Cervix uteri
Pregnancytrimester, second
Twin pregnancy
Cervicallength measurement
Systematic review
Pregnancy outcome
Pregnant women
