助产士门诊系统化管理对初产妇妊娠结局影响的研究  

Study on the effects of systematic management of midwives clinic on the outcomes of primiparas' childbirth

作　　者：朱佳蕾[1] 赵杏珍[1] 沈彩琴[1] Zhu Jialei;Zhao Xingzhen;Shen Caiqing(Maternal and Child Health Care Hospital of Shanghai Jiading Distract,Shanghai 201821)

机构地区：[1]上海市嘉定区妇幼保健院,上海201821

出　　处：《护士进修杂志》2018年第22期2019-2024,共6页Journal of Nurses Training

基　　金：上海市卫生和计划生育委员会科研课题资助项目(编号:201540354)

摘　　要：目的探讨助产士门诊系统化管理对低危孕产妇的分娩结局的影响。方法选取在我院产科门诊规律产检并在我院分娩的低危初产妇1 300例,根据坐诊时间分为对照组和观察组各650例。对照组妊娠期参加传统助产士产前咨询门诊,以医生产前检查及宣教为主导;观察组在此基础上参加助产士门诊系统化管理,由助产士产前咨询为主导,分阶段进行孕期保健知识评估指导,同时延伸至产时、产后护理。比较两组孕产妇分娩结局(分娩意向改变率、剖宫产率、新生儿Apgar评分及窒息率、新生儿体重及巨大儿、低体重儿发生率、用乳技能掌握情况、会阴侧切率)、出院后纯母乳喂养率及产后42d抑郁状态筛出率。结果观察组分娩意向由剖宫产向自然分娩转变率高于对照组,剖宫产率及侧切率均低于对照组,差异有统计学意义(P<0.05);巨大儿及低体重儿的发生率均低于对照组;两组新生儿5min及10min Apgar评分及窒息率均无统计学意义(P>0.05)。观察组产妇产后LATCH哺乳技能评分高于对照组(P<0.01)。观察组出院后42d产后回访,纯母乳喂养率明显高于对照组,产后抑郁筛出率明显低于对照组(P<0.01)。结论助产士门诊系统化管理能有效改变低危初产妇的分娩意向,降低社会因素的剖宫产率,减少会阴侧切率、产后抑郁的筛出率及巨大儿及低体重儿的发生率,提高纯母乳喂养率。Objective To study the effect of systematic management of midwives clinic on the delivery outcome of low risk pregnant women,the exclusive breastfeeding after discharge and the screening rate of depression on the 42 day after delivery,so as to provide a basis for systematic management of midwives.Methods 1300 primiparas had regular antenatal examination and delivered in our hospital was randomly divided into control group and observation group according to visiting time,650 cases in each group.Patient in control group was visited in traditional midwives clinic,the doctor was responsible for the prenatal examination and health education.Besides routine intervention,patients in observation group joined a midwife-led systematic management midwives clinic.It extended to postnatal care during childbirth.The results of maternal delivery,exclusive breastfeeding rate after discharge and the screening rate of depression after 42 days were compared between the two groups.Results Patients in two groups have the same intention of delivery,the rate of changing delivery intention in observation group was higher than that of the control group.The rates of cesarean delivery and perineotomy in observation group was lower than that of the control group(P<0.05).The incidence of macrosomes and low weight children was lower than that of control group.LATCH nursing skill score was higher than that of control group(P<0.01).Pure breastfeeding rate was significantly higher than that of control group.Postnatal depression screening rate was significantly lower than control group(P<0.01).There was no significant difference in the 5 and 10 minute Apgar score and asphyxia rate(P<0.05).Conclusion The systematic management of Midwifery outpatient clinic can effectively change the intention of delivery of low-risk first-time mothers,reduce the cesarean section rate of social factors,the rate of perineal side incisions,screening rate of postpartum depression and the incidence rate of large and low-weight children,and increase the rate of exclusi

关 键 词：助产士门诊 系统化管理 分娩意向 母乳喂养 会阴侧切率 抑郁筛出率 

分 类 号：R473.71[医药卫生—护理学] R717[医药卫生—临床医学]