Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes:a systematic review and network meta-analysis
| Autor: | Siobhan Quenby, Emma R. Honess, Khalid S. Khan, Javier Zamora, Nicky J Welton, Sarah J. Bunnewell, Shakila Thangaratinam, Bassel H. Al Wattar |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
musculoskeletal diseases
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Stethoscope law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Pregnancy law Fetal distress medicine Humans Cardiotocography 030212 general & internal medicine Fetal Monitoring Randomized Controlled Trials as Topic Fetus 030219 obstetrics & reproductive medicine medicine.diagnostic_test Cesarean Section Obstetrics business.industry Research Pregnancy Outcome General Medicine medicine.disease Confidence interval Meta-analysis Relative risk Female business |
| Zdroj: | Wattar, B H A, Honess, E, Bunnewell, S, Welton, N J, Quenby, S, Khan, K S, Zamora, J & Thangaratinam, S 2021, ' Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes : a systematic review and network meta-analysis ', CMAJ: Canadian Medical Association Journal, vol. 193, no. 14, pp. E468-E477 . https://doi.org/10.1503/cmaj.202538 Digibug. Repositorio Institucional de la Universidad de Granada instname CMAJ : Canadian Medical Association Journal Digibug: Repositorio Institucional de la Universidad de Granada Universidad de Granada (UGR) |
| DOI: | 10.1503/cmaj.202538 |
| Popis: | Bassel Al Wattar holds a personal Academic Clinical Lectureship from the UK National Health Institute of Research. Khalid Khan is a Distinguished Investigator funded by the Beatriz Galindo (senior modality) Program Grant given to the University of Granada by the Ministry of Science, Innovation, and Universities of the Spanish Government. BACKGROUND: Cesarean delivery is the most common surgical procedure worldwide. Intrapartum fetal surveillance is routinely offered to improve neonatal outcomes, but the effects of different methods on the risk of emergency cesarean deliveries remains uncertain. We conducted a systematic review and network meta-analysis to evaluate the effectiveness of different types of fetal surveillance. METHODS: We searched MEDLINE, Embase and CENTRAL until June 1, 2020, for randomized trials evaluating any intrapartum fetal surveillance method. We performed a network meta-analysis within a frequentist framework. We assessed the quality and network inconsistency of trials. We reported primarily on intrapartum emergency cesarean deliveries and other secondary maternal and neonatal outcomes using risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: We included 33 trials (118 863 patients) evaluating intermittent auscultation with Pinard stethoscope/handheld Doppler (IA), cardiotocography (CTG), computerized cardiotocography (cCTG), CTG with fetal scalp lactate (CTG-lactate), CTG with fetal scalp pH analysis (CTG-FBS), CTG with fetal pulse oximetry (FPO-CTG), CTG with fetal heart electrocardiogram (CTG-STAN) and their combinations. Intermittent auscultation reduced the risk of emergency cesarean deliveries compared with other types of surveillance (IA v. CTG: RR 0.83, 95% CI 0.72-0.97; IA v. CTG-FBS: RR 0.71, 95% CI 0.63-0.80; IA v.CTG-lactate: RR 0.77, 95% CI 0.64-0.92; IA v. FPO-CTG: RR 0.75, 95% CI 0.65-0.87; IA v.FPO-CTG-FBS: RR 0.81, 95% CI 0.67-0.99; cCTG-FBS v. IA: RR 1.21, 95% CI 1.04-1.42), except STAN-CTG-FBS (RR 1.17, 95% CI 0.98-1.40). There was a similar reduction observed for emergency cesarean deliveries for fetal distress. None of the evaluated methods was associated with a reduced risk of neonatal acidemia, neonatal unit admissions, Apgar scores or perinatal death. INTERPRETATION: Compared with other types of fetal surveillance, intermittent auscultation seems to reduce emergency cesarean deliveries in labour without increasing adverse neonatal and maternal outcomes. Beatriz Galindo (senior modality) Program Grant by Ministry of Science, Innovation, and Universities of the Spanish Government |
| Databáze: | OpenAIRE |
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