剖腹產產婦與其不良反應結果之相關性：系統性文獻回顧與統合分析研究

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Title:	剖腹產產婦與其不良反應結果之相關性：系統性文獻回顧與統合分析研究 Correlation between Previous Caesarean Section and Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis
Authors:	Rahma Novita Asdary
Contributors:	全球衛生暨發展碩士學位學程烏斯馬
Keywords:	前胎剖腹產;不良妊娠结果;Robson分類法 Previous Caesarean Section;adverse maternal outcomes;Robson classification
Date:	2019-07-09
Issue Date:	2020-03-03 15:21:26 (UTC+8)
Abstract:	Importance The increasing rates of Caesarean section (CS) beyond WHO standard (10%-15%) are a significant global health concern and become a trigger of global debate due to prospective maternal and perinatal risks related with the increasing rate, inequality in health access and cost effectiveness issue. WHO proposed the standardized manual for assessing CS rates system called Robson classification (RC) which classifies all women admitted for delivery. Objective To conduct a systematic review, meta-analysis and meta-regression to study the association between CS in the previous birth and the maternal adverse outcomes for the subsequent pregnancy and delivery among women classified in RC. Data Source and Study Selection The systematic literature searched through Ovid system (contains four databases) and Web of Science platform (contains four databases) between 2008-2018 for studies stratified by CS history and adverse maternal outcomes Data Extraction and Synthesis Data were assessed by 2 independent any disagreements were resolved through discussion with advisor. Statistical values were calculated using a random-effects model. Main Outcomes and Measures Analgesia/anesthesia administration, blood transfusion, heavy bleeding, hypertension, hysterectomy, infection, maternal death, pre-eclampsia, placenta previa, preterm delivery, retained placenta, severe maternal outcomes, uterine dehiscence and uterine rupture. Results Of 4084 identified studies, 28 (n = 1 524 695women) met inclusion criteria. Robson Classification (RC) group 5 was the highest proportion among deliveries followed by RC 10, RC 7 and RC 8 (67.708%; 32.268%; 0.023%; 0.001% respectively). Hysterectomy has highest association after preterm delivery with OR 3.390 (95% CI 1.562-7.356); followed by Severe Maternal Outcomes with OR 2.947 (95% CI 1.003-8.665) and Pre-eclampsia 2.759 (95% CI 0.711-10.713). The inverse association were found in two outcomes. The previous CS were associated with lower both blood transfusion and uterine rupture with OR 0.679 (95% CI 0.170-2.713) and OR 0.730 (95% CI 0.333-1.604) respectively Conclusion and Relevance In this systematic review and meta-analysis of more than 1 million pregnant women (67.708%) were grouped in the RC 5. All of the RC groups increased the odds of the adverse maternal outcomes for the subsequent pregnancies.
Description:	碩士指導教授：烏斯馬委員：黃麗玲委員：陳再晉
Data Type:	thesis
Appears in Collections:	[Master Program in Global Health and Development] Dissertations/Theses

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