优化高危妊娠管理模式初探  

Preliminary exploration on optimized management model for high risk pregnancy

作　　者：董晓超[1] 秦敏[1] 杜莉[1] 朱丽萍[1] 

机构地区：[1]上海市妇女保健所同济大学附属第一妇婴保健院

出　　处：《中国妇幼保健》2010年第15期2033-2036,共4页Maternal and Child Health Care of China

基　　金：卫生部社区孕产妇保健适宜技术规范推广的研究(SHDC12007222);上海市公共卫生体系建设新三年行动计划(2007~2009)项目

摘　　要：目的:探讨新的高危妊娠管理模式,提高对孕期重点人群的保健质量,进一步降低孕产妇死亡率。方法:从高危筛查、转诊、确诊、随访等管理环节对上海市现行的高危妊娠管理模式进行修订,设计新的重点孕妇管理方案,并在全市各区(县)试点,通过新方案实施前后(2008年4～9月与2009年4～9月)的高危妊娠管理成效对比,评估该方案的优越性。结果:新方案实施后,高危筛查的疾病阳性预测值从28.17%提高到45.83%(P<0.01);转诊单回收率从49.58%增加到71.77%(P<0.01),转诊周期从(31.75±9.57)天缩短到(14.56±3.97)天(P<0.01);随访落实率从63.14%提高到77.40%(P<0.01),失访率从7.63%下降到2.88%(P<0.05);全市共确诊重点孕妇841人,确诊不宜继续妊娠孕妇9人并已安全终止妊娠;新方案的实施者(医务人员)与接受者(孕妇)对该方案的各项工作给予了肯定与好评。结论:新的重点孕妇管理方案提高了疾病筛查效果,使转诊与随访更加及时、落实,此方案的不断完善终将形成一个更加优化的高危妊娠管理模式。Objective： To explore a new management model for high risk pregnancy so as to improve the quality of health care for target population and further reduce maternal mortality. Methods： A new management scheme for key pregnant women with high risk disea- ses, involving disease screening, referral, confirmed diagnosis and follow -up visits, was designed to replace the traditional management model for high risk pregnancy, which was applied to some pilot study areas in every administrative district in Shanghai. The effects of management were evaluated by pre - post data comparison （ from April to September 2008 vs April to September 2009 ）, the superiority of the new management model was evaluated. Results： After the implementation of new scheme, the positive predictive value of disease screening in- creased from 28. 17% to 45.83% （P 〈0. 01 ） ; the feedback rate of cards for referral increased from 49.58% to 71.77% （P 〈0. 01 ）, and the referral cycle shortened from （31.75 ± 9. 57） days to （ 14. 56 ± 3.97） days （P 〈0. 01 ） ; the follow - up rate increased from 63.14% to 77.40% （P 〈 0. 01 ）, and the loss of follow - up rate decreased from 7. 63% to 2. 88% （P 〈 0.05 ） ; totally, 841 pregnant women were diagnosed as key pregnant women, and 9 pregnant women terminated pregnancy safely as they were confirmed unsuitable to continue pregnancy; the health care providers （medical staff） and the recipients （pregnant women） involved in the scheme were satisfied with the new man- agement model. Conclusion ： The new management scheme for key pregnant women with high risk diseases has improved the efficacy of dis- ease screening, and also made the referral and follow -up more timely and easier to implement. So it＇s worthy to popularize the new model with further modification.

关 键 词：高危妊娠 重点孕妇 管理模式 优化 

分 类 号：R17[医药卫生—妇幼卫生保健]