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Descompresión abdominal para la sospecha de compromiso fetal/pre‐eclampsia

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Referencias

References to studies included in this review

Ir a:

Blecher 1967 {published data only}

Blecher JA. Aspects of the physiology of decompression and its usage in the toxaemias of pregnancy and in fetal distress in labour [MD thesis]. South Africa: University of the Witwatersrand, 1967.

MacRae 1971 {published data only}

MacRae DJ, Mohamedally SM, Willmott MP. Clinical and endocrinological aspects of dysmaturity and the use of intermittent abdominal decompression in pregnancy. Journal of Obstetrics and Gynaecology of the British Commonwealth 1971;78:636‐41.

Varma 1973 {published data only}

Varma TR, Curzen P. The effects of abdominal decompression on pregnancy complicated by the small‐for‐dates fetus. Journal of Obstetrics and Gynaecology of the British Commonwealth 1973;80:1086‐94.

References to studies excluded from this review

Ir a:

Coppola 1985 {published data only}

Coppola F, Battioni M, Vessichelli R, Daoh KS, Bacchi‐Modena A. Auxologic results of abdominal decompression in growth disorders of the fetus. Minerva Ginecologica1985; Vol. 37, issue 11:645‐52. [CN‐00279572]

Additional references

Ir a:

Clarke 1999

Clarke M, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.0 [updated July 1999]. In: Review Manager (RevMan) [Computer program]. Version 4.0. Oxford, England: The Cochrane Collaboration, 1999.

Hofmeyr 1989

Hofmeyr GJ. Abdominal decompression during pregnancy. In: Chalmers I, Enkin MW, Keirse MJNC editor(s). Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989:647‐652.

RevMan 1999 [Computer program]

Update Software. Review Manager (RevMan). Version 4.0. Oxford, England: Update Software, 1999.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Blecher 1967

Methods

Alternation.

Participants

Women with pre‐eclampsia, essential hypertension or chronic nephritis.

Interventions

Women who received abdominal decompression compared with control group.

Outcomes

"Unchanged or worsening pre‐eclampsia"; induction of labour; low birthweight; perinatal mortality.

Notes

Assessment of pre‐eclampsia as "unchanged" or "worsening" somewhat subjective.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

High risk

Inadequate
MacRae 1971

Methods

Selected "at random", method not specified.

Participants

Women with fetuses estimated to be small for gestational age and urinary oestriol levels below the normal range.

Interventions

Participants were allocated either to receive repeated abdominal decompression, or to act as controls.

Outcomes

Urinary oestriol levels; perinatal mortality.

Notes

Reported significantly greater urinary oestriol increase with abdominal decompression, but data not given.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

High risk

Inadequate
Varma 1973

Methods

Alternation. Allocation of 7 women from each group changed because of non‐acceptance of abdominal decompression.

Participants

Women with clinically "small for dates" fetuses and biparietal diameters below the 10th percentile.

Interventions

Women who received abdominal decompression compared with control group.

Outcomes

Induction of labour; induction of labour for placental insufficiency; fetal distress in labour; low birthweight; Apgar score <6 at 1 minute; perinatal mortality; urinary oestriol increase (mean 1.68 mg per week [sd 1.21] versus 0.91 [0.74]; weekly growth in fetal biparietal diameter (2.08 [0.36] versus 1.49 [0.71])

Notes

Use of reduced biparietal diameter as a selection criterion may have resulted in the inclusion of women with incorrect dates rather than growth impairment.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment (selection bias)

High risk

Inadequate

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Coppola 1985

Allocation was not stated to be randomized or quasi‐randomized.  Women with fetal growth impairment at 32 to 34 weeks’ gestation were divided into 2 groups.  Fourteen women received abdominal decompression to ‐50 to ‐70mmhg for 15‐30 second per minute for 30 minutes, twice a week. Twelve women acted as controls (bedrest).  There appeared to be improved growth in the decompression group.

Data and analyses

Open in table viewer
Comparison 1. Abdominal decompression for suspected fetal compromise/pre‐eclampsia

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Unchanged or worsening pre‐eclampsia Show forest plot

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.18, 0.72]
Analysis 1.1
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 1 Unchanged or worsening pre‐eclampsia.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 1 Unchanged or worsening pre‐eclampsia.

2 Induction of labour (all indications) Show forest plot

2

300

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.75, 1.25]
Analysis 1.2
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 2 Induction of labour (all indications).

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 2 Induction of labour (all indications).

3 Induction for placental insufficiency Show forest plot

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.46, 1.19]
Analysis 1.3
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 3 Induction for placental insufficiency.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 3 Induction for placental insufficiency.

4 Fetal distress in labour Show forest plot

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.19, 0.71]
Analysis 1.4
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 4 Fetal distress in labour.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 4 Fetal distress in labour.

5 Low birthweight Show forest plot

2

304

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.40, 0.63]
Analysis 1.5
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 5 Low birthweight.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 5 Low birthweight.

6 Apgar score <6 at 1 minute Show forest plot

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.12, 0.56]
Analysis 1.6
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 6 Apgar score <6 at 1 minute.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 6 Apgar score <6 at 1 minute.

7 Perinatal mortality Show forest plot

3

367

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.22, 0.71]
Analysis 1.7
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 7 Perinatal mortality.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 7 Perinatal mortality.

8 Urinary oestriol increase mg per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.8
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 8 Urinary oestriol increase mg per week.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 8 Urinary oestriol increase mg per week.

9 Fetal biparietal diameter increase mm per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.9
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 9 Fetal biparietal diameter increase mm per week.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 9 Fetal biparietal diameter increase mm per week.

10 Birthweight Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 1.10
Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 10 Birthweight.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 10 Birthweight.

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 1 Unchanged or worsening pre‐eclampsia.
Figuras y tablas -
Analysis 1.1

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 1 Unchanged or worsening pre‐eclampsia.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 2 Induction of labour (all indications).
Figuras y tablas -
Analysis 1.2

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 2 Induction of labour (all indications).

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 3 Induction for placental insufficiency.
Figuras y tablas -
Analysis 1.3

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 3 Induction for placental insufficiency.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 4 Fetal distress in labour.
Figuras y tablas -
Analysis 1.4

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 4 Fetal distress in labour.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 5 Low birthweight.
Figuras y tablas -
Analysis 1.5

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 5 Low birthweight.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 6 Apgar score <6 at 1 minute.
Figuras y tablas -
Analysis 1.6

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 6 Apgar score <6 at 1 minute.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 7 Perinatal mortality.
Figuras y tablas -
Analysis 1.7

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 7 Perinatal mortality.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 8 Urinary oestriol increase mg per week.
Figuras y tablas -
Analysis 1.8

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 8 Urinary oestriol increase mg per week.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 9 Fetal biparietal diameter increase mm per week.
Figuras y tablas -
Analysis 1.9

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 9 Fetal biparietal diameter increase mm per week.

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Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 10 Birthweight.
Figuras y tablas -
Analysis 1.10

Comparison 1 Abdominal decompression for suspected fetal compromise/pre‐eclampsia, Outcome 10 Birthweight.

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Comparison 1. Abdominal decompression for suspected fetal compromise/pre‐eclampsia

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Unchanged or worsening pre‐eclampsia Show forest plot

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.18, 0.72]

2 Induction of labour (all indications) Show forest plot

2

300

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.75, 1.25]

3 Induction for placental insufficiency Show forest plot

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.46, 1.19]

4 Fetal distress in labour Show forest plot

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.19, 0.71]

5 Low birthweight Show forest plot

2

304

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.40, 0.63]

6 Apgar score <6 at 1 minute Show forest plot

1

140

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.12, 0.56]

7 Perinatal mortality Show forest plot

3

367

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.22, 0.71]

8 Urinary oestriol increase mg per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9 Fetal biparietal diameter increase mm per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10 Birthweight Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Abdominal decompression for suspected fetal compromise/pre‐eclampsia
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