辅助干预措施在臀先露外倒转术中的有效性与安全性：一项系统评价和荟萃分析。
完整摘要 · 中文译文
目的：评估与臀位孕妇外倒转术（ECV）相关的辅助策略及实施相关策略的有效性和安全性。 方法：纳入比较与ECV相关的辅助或方案化策略（包括药物性宫缩抑制、椎管内麻醉或镇痛、全身性镇痛，或时机/操作流程方法）与标准护理、安慰剂或期待管理的随机对照试验。 检索策略：检索MEDLINE (PubMed)、Embase、Scopus、Cochrane CENTRAL和LILACS，检索时间从建库至2026年2月。 数据选择与提取：由两名 reviewers独立进行数据提取和使用Cochrane RoB 2工具进行偏倚风险评估。二分类结局在随机效应模型下使用风险比（RR）及95%置信区间（CI）进行合并。 结果：共纳入10项随机对照试验，包括2,745名随机分配的孕妇；其中2,722名提供了完整的结局数据用于主要荟萃分析。辅助策略及实施相关策略与较高的ECV成功率相关（RR 1.53；95% CI 1.15-2.04；I² = 87%）。药物性宫缩抑制显示效果最大（RR 2.39；95% CI 1.39-4.11），其次是椎管内麻醉（RR 1.75；95% CI 1.07-2.85）和全身性镇痛（RR 1.39；95% CI 1.15-1.69）。方案化策略未显著提高成功率。剖宫产率未见统计学显著降低（RR 0.88；95% CI 0.76-1.02）。严重母体和新生儿并发症不常见。 结论：辅助性及实施相关策略，尤其是药物性宫缩抑制和椎管内麻醉，可提高外倒转术（ECV）成功的可能性。尽管其对剖宫产分娩的影响尚不确定，但在适当的临床条件下实施外倒转术（ECV）似乎是安全的。
完整摘要 · 英文原文
OBJECTIVE: To evaluate the efficacy and safety of adjunct and implementation-related strategies associated with external cephalic version (ECV) in pregnant women with breech presentation. METHODS: Randomized controlled trials comparing adjunct or protocol-based strategies related to ECV (including pharmacological tocolysis, neuraxial anesthesia or analgesia, systemic analgesia, or timing/procedural approaches) with standard care, placebo, or expectant management were included. SEARCH STRATEGY: MEDLINE (PubMed), Embase, Scopus, Cochrane CENTRAL, and LILACS were searched from inception to February 2026. DATA SELECTION AND EXTRACTION: Data extraction and risk of bias assessment using the Cochrane RoB 2 tool were performed independently by two reviewers. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CI) under random-effects models. RESULTS: Ten randomized controlled trials comprising 2,745 randomized women were included; 2,722 contributed complete outcome data to the primary meta-analysis. Adjunct and implementation-related strategies were associated with higher ECV success rates (RR 1.53; 95% CI 1.15-2.04; I² = 87%). Pharmacological tocolysis demonstrated the largest effect (RR 2.39; 95% CI 1.39-4.11), followed by neuraxial anesthesia (RR 1.75; 95% CI 1.07-2.85) and systemic analgesia (RR 1.39; 95% CI 1.15-1.69). Protocol-based strategies did not significantly improve success rates. No statistically significant reduction in cesarean delivery was observed (RR 0.88; 95% CI 0.76-1.02). Serious maternal and neonatal complications were uncommon. CONCLUSIONS: Adjunct and implementation-related strategies, particularly pharmacological tocolysis and neuraxial anesthesia, increase the likelihood of successful ECV. Although the effect on cesarean delivery remains inconclusive, ECV appears safe when performed in appropriate clinical settings.