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Intervention Review

Abdominal decompression for suspected fetal compromise/pre-eclampsia

  1. G Justus Hofmeyr*

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 22 APR 1996

Assessed as up-to-date: 28 OCT 2008

DOI: 10.1002/14651858.CD000004


How to Cite

Hofmeyr GJ. Abdominal decompression for suspected fetal compromise/pre-eclampsia. Cochrane Database of Systematic Reviews 1996, Issue 1. Art. No.: CD000004. DOI: 10.1002/14651858.CD000004.

Author Information

  1. University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa

*G Justus Hofmeyr, Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, 5200, South Africa. justhof@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 APR 1996

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Abdominal decompression was developed as a means of pain relief during labour. It has also been used for complications of pregnancy, and in healthy pregnant women in an attempt to improve fetal wellbeing and intellectual development.

Objectives

The objective of this review was to assess the effects of antenatal abdominal decompression for maternal hypertension or impaired fetal growth, on perinatal outcome.

Search methods

The Cochrane Pregnancy and Childbirth Group's Trials Register (October 2008).

Selection criteria

Randomised or quasi-randomised trials comparing abdominal decompression with no decompression in women with pre-eclampsia and/or fetuses thought to be compromised.

Data collection and analysis

Eligibility and trial quality were assessed by one review author.

Main results

Three studies were included, all with the possibility of containing serious bias. Therapeutic abdominal decompression was associated with the following reductions: persistent pre-eclampsia (relative risk 0.36, 95% confidence interval 0.18 to 0.72); fetal distress in labour (relative risk 0.37, 95% confidence interval 0.19 to 0.71); low birthweight (relative risk 0.50, 95% confidence interval 0.40 to 0.63); Apgar scores less than six at one minute (relative risk 0.26, 95% confidence interval 0.12 to 0.56); and perinatal mortality (relative risk 0.39, 95% confidence interval 0.22 to 0.71).

Authors' conclusions

Due to the methodological limitations of the studies, the effects of therapeutic abdominal decompression are not clear. The apparent improvements in birthweight and perinatal mortality warrant further evaluation of abdominal decompression where there is impaired fetal growth and possibly for women with pre-eclampsia.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antenatal abdominal decompression for maternal hypertension or impaired fetal growth

Abdominal decompression was first used to increase blood flow and the forward movement of the uterus during labour contractions as a way of relieving pain. A rigid covered dome is placed about the abdomen and the space around the abdomen is decompressed to -50 to -100 mm Hg for 15 to 30 seconds out of each minute for 30 minutes once to thrice daily, or continuously during labour. Observations that fetal wellbeing appeared to be improved led to its investigation for complications of pregnancy.

Three randomised controlled studies with a total of 356 pregnant women were identified from a search of the medical literature, all with the possibility of containing serious methodological limitations. The studies were reported on between 1967 and 1973. One study involved women with pre-eclampsia, essential hypertension, or chronic nephritis. The other two trials assigned women carrying babies that were small for their gestational age to abdominal decompression or no decompression.

Abdominal decompression appeared to have a beneficial effect on the progression of pre-eclampsia. This one trial also reported less fetal distress during labour and fewer low 1-minute Apgar scores in the group who received abdominal decompression. The apparent large improvement in birthweight and perinatal deaths reported in all three studies is sufficiently striking to warrant the further evaluation of abdominal decompression in cases of impaired fetal growth, and possibly for women with pre-eclampsia, by means of methodologically sound controlled trials. Because of the methodological shortcomings mentioned above, clinical use of abdominal decompression cannot be supported on the basis of the present trials.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在懷疑有胎兒窘迫/母體有子癲前症的孕婦身上,使用腹部減壓法的效果

「腹部減壓法」最早是被發展出來減輕產痛的一個方法。後來曾被應用到妊娠合併症,甚至是正常健康的孕婦身上,目的是看可不可以改善胎兒生理及智力的狀況。

目標

本文獻回顧的目的是要評估,在母體有高血壓或有胎兒生長遲滯的孕婦身上,腹部減壓法對周產期預後的影響。

搜尋策略

我們搜尋出現在The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register的相關文獻;最後一次搜尋的日期是2004年10月25日。

選擇標準

所有針對子癲前症婦女,無論有無合併胎兒窘迫,所進行比較有無使用腹部減壓法的效果的隨機或準隨機式的臨床試驗。

資料收集與分析

一位作者評估這些研究是否適合分析以及試驗的品質如何。

主要結論

總共找到3個試驗,但是都有嚴重的偏差。治療性的腹部減壓可以減少下列情況的發生:持續性的子癲前症(相對危險性RR 0.36,95% C .18 – 0.72);待產時出現胎兒窘迫(RR 0.37,95% CI 0.19 – 0.71);低出生體重(RR 0.50,95% CI 0.40 – 0.63);出生後1分鐘Apgar評分小於6(R .26,95% CI 0.12 – 0.56);以及周產期死亡率(RR 0.39,95% C .22 – 0.71)。

作者結論

由於這些研究都有方法學上的限制,所以治療性腹部減壓法的效果仍然不明。但是基於在出生體重及周產期死亡率方面有明顯的改善的情況,針對胎兒生長遲滯甚至是子癲前症的婦女使用腹部減壓的效果,值得進一步的評估。

翻譯人

本摘要由周產期醫學會(Taiwan Society of Perinatology)洪泰和翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

摘要仍在撰寫中。