Meta-analysis of risk factors for episiotomy in vaginal delivery in primiparas
Objective To analyze the risk factors for episiotomy in vaginal delivery in primiparas.Methods Cochrane Library,PubMed,Embase,Web of Science,CBM,CNKI,Wanfang Medical Network,VIP Chinese Technology Periodical Database were searched.Co-hort studies,case-control studies or cross-sectional surveys on the risk factors for episiotomy in primiparas were collected from the database establishment to July 20,2023.Researcher screened the relevant literature,extracted the required data and evaluated the quality of the litera-ture according to the specifications.RevMan 5.4.1 software was used for quantitative Meta-analysis.Results A total of 16 literatures were in-cluded,including 48 513 primiparas,22 818 cases of episiotomy,the episiotomy rate was 47.03%.A total of 18 risk factors were identified,in-cluding 5 maternal risk factors,7 fetal risk factors,5 medical interventions,and 1 medical staff risk factors.Meta-analysis showed that the risk factors for primigravid in primiparas included the following:maternal risk factors were prolongation of the second stage of labor＞1 h[OR=2.88,95%CI(2.50,3.32),P＜0.001],prolongation of the second stage of labor＞3 h[OR=2.04,95%CI(1.69,2.46),P＜0.001]and perineal ede-ma[OR=5.65,95%CI(3.87,8.24),P＜0.001],neonatal factors were meconium stained amniotic fluid[OR=1.88,95%CI(1.56,2.27),P＜0.001],fetal distress[OR=6.38,95%CI(4.72,8.63),P＜0.001],fetal weight≥3 500 g[OR=1.67,95%CI(1.28,2.18),P＜0.001]and macrosomia[OR=1.53,95%CI(1.31,1.79),P＜0.001],medical intervention measures were anesthesia analgesia[OR= 1.20,95%CI(1.13,1.26),P＜0.001],forceps delivery[OR=13.11,95%CI(3.07,55.93),P＜0.001],induction of labor[OR=1.22,95%CI(1.10,1.35),P＜0.001],and fetal head extraction[OR=18.62,95%CI(8.00,43.34),P＜0.001],and the rest of the factors did not influence wheth-er or not the primigravida underwent episiotomy.Conclusion The multiple risk factors identified in the study can be used as predictive tools to promote the formation of future clinical practice consensus and reduce the poor prognosis of episiotomy based on unreasonable factors.
万方数据
维普
