自然分娩的产时服务模式探讨  

Study on intrapartum service model during normal labor

作　　者：黄醒华[1] 项小英[2] 沈汝棡[1] 尚琪[3] 朱丽萍[4] 钱序[5] 范玲[1] 段明英[6] 熊永芳[7] 门新华[8] 

机构地区：[1]首都医科大学附属北京妇产医院,100026 [2]北京市妇女保健所 [3]中国疾病预防控制中心环境卫生研究所 [4]上海市第一妇婴保健院 [5]上海复旦大学医学部 [6]济南市妇幼保健院 [7]湖北省妇幼保健院 [8]大连市妇产医院

出　　处：《中华妇产科杂志》2003年第7期385-387,共3页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　探讨实施以人为本 ,以循证医学为指导的人性化产时服务模式、促进健康分娩的可行性 ,并评价该模式对母婴预后的影响。方法　从 2 0 0 0年 11月～ 2 0 0 1年 6月 ,在全国 6个城市 9所医院进行多中心前瞻性随机对照实验 ,将决定阴道分娩的 6 75 8例产妇随机分为研究组 (3437例 )和对照组 (332 1例 )。研究组实施全产程 (从临产到第四产程结束 )陪产。按WHO推荐的常用适宜技术 ,对产妇进行生理、心理、体力的全面支持 ,对照组按常规处理。分娩次日由专人填写调查问卷。结果　研究组自然分娩率为 85 5 % ,明显高于对照组的 6 6 0 % ,差异有极显著性 (P <0 0 1) ,研究组剖宫产率为 8 1% ,明显低于对照组的 2 8 6 % ,差异也有极显著性 (P <0 0 1)。研究组产后出血率、新生儿窒息发生率、新生儿病率明显低于对照组 (P <0 0 5 )。研究组产妇产程中精神紧张、担心、害怕的程度 ,比对照组明显减轻 (P <0 0 1) ,而精神放松及配合产程者明显多于对照组。结论　适宜的产时服务模式 ,可降低剖宫产率。Objective To study the availability of humanized service and healthy birth and it's effect on maternal and neonatal outcomes Methods A multicenteral prospective randomized control study was carried out in 9 maternity hospitals from Nov 2000 to June 2001 6 758 laboring women were randomly devided into study group and control group In study group ( n =3 437),midwives accompany laboring women in whole course of birth until two hours after delivery According WHO 'Monitoring rules for normal birth' medical staff support the mothers in physiological,psychological and physical aspects In control group ( n =3 321) mothers receive tranditional management Midwives visit and check the mothers discoutinually In two groups husbands can company laboring women according women's requirement A questionnaire will be filled on the second day after birth Results In study group the spontaneous delivery rate was significant higher than that of control group (85 5% vs 66 0%, P <0 01). The cesarean section rate,postpartum hemorrhage rate, neonatal asphyxia rate and neonatal morbidity were marked lower in study group than those of control group ( P <0 01 and P <0 05) Conclusions Appropriate mode of intrapartum care can decrease the cesarean section rate and promote the vaginal delivery,also it can improve the maternal and neonatal outcomes

关 键 词：自然分娩 产时服务模式 医疗护理 前瞻性研究 循证医学 

分 类 号：R714.7[医药卫生—妇产科学]