Objective

The aim of this systematic review and meta-analysis was to assess the benefits and risks of spontaneous pushing and directed pushing used by labouring women without epidural analgesia during the second stage labour.

Design

Systematic review and meta-analysis.

Methods

Randomised controlled trials published in PubMed/ MEDLINE, CINAHL, Web of Science, Scopus, EMBASE, psycINFO, the Cochrane Library, and four Chinese databases were systematically searched from their inception to December, 2021. Grey literature were also searched. Two authors independently screened the literature and evaluated the quality of the included studies.

Results

Ten studies with a total of 1510 women were pooled. Spontaneous pushing in the second stage of labour reduced the rates of Caesarean section and extended episiotomy. The difference was significant among spontaneous pushing group and directed pushing group, with relative risk and 95% confidence intervals of 0.42 and 0.19–0.94, 0.49 and 0.29–0.82, respectively. There was no significant difference in the duration of the second stage of labour, rates of spontaneous vaginal birth and newborn outcomes.

Conclusion

The results of this meta-analysis demonstrate that spontaneous pushing during the second stage of labour results in at least the same maternal and newborn outcomes, lower Caesarean section rates and lower incidence of extended episiotomy.

中文翻译：

---

未使用硬膜外镇痛的妇女在第二产程中自然推动与直接推动的益处和风险：系统评价和荟萃分析

客观的

本系统评价和荟萃分析的目的是评估未使用硬膜外镇痛的分娩妇女在第二产程中使用自发推动和定向推动的益处和风险。

设计

系统评价和荟萃分析。

方法

对发表在 PubMed/MEDLINE、CINAHL、Web of Science、Scopus、EMBASE、psycINFO、Cochrane 图书馆和四个中文数据库上的随机对照试验进行了系统检索，检索时间为 2021 年 12 月。同时检索了灰色文献。两位作者独立筛选文献并评估纳入研究的质量。

结果

共有 1510 名女性参与了 10 项研究。第二产程的自然推动降低了剖宫产率并延长了会阴切开术。自发推动组和定向推动组之间差异显着，相对风险和 95% 置信区间分别为 0.42 和 0.19-0.94、0.49 和 0.29-0.82。第二产程持续时间、自然阴道分娩率和新生儿结局没有显着差异。

结论

这项荟萃分析的结果表明，在第二产程期间，自发推动至少可以产生相同的孕产妇和新生儿结局、更低的剖宫产率和更低的会阴切开率。