降低剖宫产率的措施Meta分析-公共卫生（临床营养）专业论文.docxVIP

PAGE PAGE 2 （7）多种措施同时采用，将增加各种方法的有效性。 [关键词] meta 分析 剖宫产率 干预措施 母婴结局 Strategies for Reducing Cesarean Section Rates: A Meta-Analysis Abstract Objective: The objectives of this meta-analysis were to assess the effectiveness of interventions for reducing the cesarean section rates and to assess the impact of this reduction on maternal and perinatal mortality and morbidity. Methods: The relative Chinese and English databases were consulted systematically to search prospective and retrospective studies , which involved rigorous evaluation of a strategy for reducing cesarean section rates. Specific information was abstracted, and then heterogeneity , meta-analysis and meta-regression were computed using STATA version 12.0. Results: Among the 14 included studies, a significant reduction of cesarean section rate was found by random meta-analysis ( pooled RR=0.93[0.91-0.95] ). No evidence of publication bias was identified. To a large extent four covariables explained the variation. They were strategy used, number of centers, total number of women and type of providers. The study included six kinds of strategies. Audit and feedback ( pooled RR=0.951[0.932,0.971] ), quality improvement ( pooled RR=0.791[0.744,0.84]), multifaceted strategies（pooled RR =0.831[0.77-0.88]）， psychoprophylaxis（pooled RR =0.681[0.49-0.95]），educational strategy（pooled RR =0.850[0.42-1.71]），doula（pooled RR =0.590 [0.39-0.90]）. Among included studies, no significant differences were found for perinatal and neonatal mortality and perinatal and maternal morbidity with respect to the mode of delivery. Two studies showed a significant reduction of NICU admission rate. One study showed rate of low Apgar score at one-minutes (7) decrease statistically. Conclusion: Active management of labor, which was consisted of organizational component and medical component, was efficient in reducing cesarean section rate and the total duration of labor. In addition, it have no impact on maternal and perinatal mortality