Intervention Review

Operative versus conservative management for 'fetal distress' in labour

  1. G Justus Hofmeyr1,*,
  2. Regina Kulier2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 23 JUN 2009

DOI: 10.1002/14651858.CD001065

Database Title

Additional Information

How to Cite

Hofmeyr GJ, Kulier R. Operative versus conservative management for 'fetal distress' in labour. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD001065. DOI: 10.1002/14651858.CD001065.

Author Information

  1. 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

  2. 2

    Geneva Foundation for Medical Education and Research, Geneva, Switzerland

*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: 7 OCT 2009

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Abstract

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

Background

Suspected fetal distress usually results in expedited delivery of a baby (often operatively). The potential harm to a mother and baby from operative delivery may not always be justified especially when fetal distress may be misdiagnosed. Even with a correct diagnosis it is not clear whether an operative or conservative approach is better.

Objectives

The objective of this review was to assess the effects of operative management for fetal distress on maternal and perinatal morbidity.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2009).

Selection criteria

Randomised trials of operative (caesarean section or expedited vaginal delivery) versus conservative management of suspected fetal distress.

Data collection and analysis

Trial quality assessment and data extraction were done by both review authors.

Main results

One study of 350 women was included. This trial was carried out in 1959. There was no difference in perinatal mortality (risk ratio 1.18, 95% confidence interval 0.56 to 2.48).

Authors' conclusions

There have been no contemporary trials of operative versus conservative management of suspected fetal distress. In settings without modern obstetric facilities, a policy of operative delivery in the event of meconium-stained liquor or fetal heart rate changes has not been shown to reduce perinatal mortality.

 

Plain language summary

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

Operative versus conservative management for 'fetal distress' in labour

Too little evidence to show whether relieving factors causing a baby's distress during labour is better than birth with caesarean, forceps or ventouse intervention.

Babies showing signs of distress during labour (unusual heart rates or the passing of a bowel motion) are at greater risk of complications following their birth. Operative management, such as surgery to remove the baby through the woman's abdomen (caesarean delivery) or the use of surgical instruments for vaginal delivery may be offered. The review of one study (350 women) found too little evidence to show whether operative management is more beneficial than treating factors which may be causing the baby's distress, such as too little fluid surrounding the baby, the woman's physical position or pain relief (conservative management). Further research is needed.

 

摘要

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

背景

手術與保守處理分娩期間「胎兒窘迫」的比較

若有疑似胎兒窘迫的情形，通常都會儘快讓嬰兒出生(常常是以手術方式)。讓母親和嬰兒暴露在手術生產方式的潛在危險下並不總是合理的，特別是有可能誤診胎兒窘迫的時候。即便有了正確的診斷，還是無法知道手術或是保守方法何者較佳。

目標

此文獻回顧的目的就是要評估手術處理胎兒窘迫對母親和周產期發病率的影響。

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group's Trials Register(2006年3月)。

選擇標準

比較手術(剖腹產或加速陰道生產)和保守處理疑似胎兒窘迫的隨機試驗。

資料收集與分析

2位回顧作者完成了試驗品質的評估與資料選用。

主要結論

納入了1個有350名婦女的研究，這個試驗是在1959年完成的。在周產兒死亡率方面並沒有差異(相對風險為 1.18, 95% 信賴區間為 0.56 – 2.48)。

作者結論

沒有同時代比較手術與保守處理疑似胎窘迫的試驗。在沒有現代化產科設備的醫院裡如果發生了羊水胎便染色或胎兒心跳速率改變時，以手術方式生產的策略沒有辦法證明可以降低周產期死亡率。

翻譯人

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

總結

因證據太少而不足以證實緩解分娩期間引起胎兒窘迫的原因，是否會優於剖腹、產鉗或是真空吸引等幫助生產的方式。在分娩期間表現出窘迫徵兆(不正常的心跳速率或是排出胎便)的嬰兒出生後會有較高的風險發生併發症。此時醫護人員可能會給予手術處理，例如剖腹生產或是器械輔助的陰道產。此文獻回顧發現證據太少而不足以證明手術處理是否會優於治療可能引起胎兒窘迫的因素，這些因素包括羊水太少、婦女的姿勢或是疼痛緩解(保守處理)，因此還需要更進一步研究。

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