低危孕妇孕产保健服务方案的临床实施效果评价  

Clinical evaluation of the implementation outcomes of the maternity care program for low-risk pregnant women

作　　者：顾春怡[1,2] 郭琳 朱新丽[4] 王晓娇 孙丽萍 朱春香 闵辉[3] 钱序 丁焱[1] Gu Chunyi;Guo Lin;Zhu Xinli;Wang Xiaojiao;Sun Liping;Zhu Chunxiang;Min Hui;Qian Xu;Ding Yan(Nursing Department,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院护理部,上海200011 [2]复旦大学公共卫生学院,国家卫生健康委员会卫生技术评估重点实验室 [3]复旦大学附属妇产科医院产房,上海200011 [4]复旦大学附属妇产科医院产科门诊,上海200011

出　　处：《护理学杂志》2024年第15期27-32,共6页Journal of Nursing Science

基　　金：国家自然科学基金资助项目(71874030);上海市卫生健康委员会卫生行业临床研究专项(202040097)。

摘　　要：目的评价以助产士为主导的低危孕妇孕产保健服务方案的应用效果。方法将在上海市某三甲妇产科医院预约初诊建卡的低危孕妇随机分为干预组485例和对照组499例。对照组接受以产科医生为主导的常规孕产保健服务;干预组在对照组的基础上接受以助产士为主导的低危孕妇孕产保健服务方案,包括孕期8次助产士门诊访视、微信群组干预及电话访视、产时陪伴分娩及产后访视。结果干预组助产士门诊访视中位数为7次,分娩计划制定率和执行率分别为76.70%和84.68%。干预组剖宫产率为27.68%,显著低于对照组的35.25%(P<0.05)。干预组硬膜外镇痛率、人工破膜率、会阴切开率、新生儿转入NICU率、第三产程出血量、产后2 h出血量及总出血量显著低于对照组(均P<0.05)。干预组孕期保健服务体验、分娩体验、产后保健服务体验、孕晚期生殖健康素养、产前母乳喂养自我效能、分娩自我效能评分及出院前纯母乳喂养率显著高于对照组(均P<0.05)。结论以助产士为主导的低危孕妇孕产保健服务方案的临床实施有利于促进正常妊娠分娩,提升孕产保健服务体验,实现孕产妇和助产士之间的双重赋能。Objective To implement a midwife-led maternity care program and to evaluate its effectiveness for low-risk pregnant women.Methods Low-risk pregnant women who made an appointment at a tertiary obstetrics and gynecology hospital in Shanghai were selected as the study objects,and were randomly divided into an intervention group(n=485)and a control group(n=499).The control group received routine prenatal health services led by obstetricians,and routine obstetric care services were performed during intrapartum and postpartum periods,while the intervention group additionally received a midwife-led maternity care program,including eight antenatal contacts in the midwife′s outpatient clinic,WeChat group intervention and telephone visits,conti-nuous labor support and postpartum visits.Results In the intervention group,the median number of antenatal contacts with midwives was 7 times.The rate of birth plan making and its implementation rate were 76.70%and 84.68%,respectively.Women in the intervention group experienced lower cesarean section rate(27.68%)than that in the control group(35.25%)(P<0.05).Women in the intervention group experienced lower chances of epidural analgesia,amniotomy,episiotomy and NICU admission,less amount of bleeding in the third stage of labor and 2 hours postpartum,and less amount of total bleeding(all P<0.05).The total scores of women′s antenatal care experience,childbirth experience,postnatal care experience,reproductive health literacy in late trimester,antenatal breast-feeding self-efficacy,childbirth self-efficacy,and the rate of exclusive breastfeeding before discharge were all significantly higher in the intervention group than those in the control group(all P<0.05).Conclusion The implementation of the midwife-led maternity care program can promote low-risk women′s normal pregnancy and childbirth,improve women′s ante-,intra-,and postnatal care experience,and achieve the two-way empowerment between women and midwives.

关 键 词：低危孕妇 孕产保健 助产士 分娩自我效能 生殖健康素养 母乳喂养 分娩体验 产科护理 

分 类 号：R473.71[医药卫生—护理学]