减少健康妇女和婴儿的不必要剖腹产的干预措施
Ana Pilar Betrán1, Marleen Temmerman2, Carol Kingdon3
1UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Lancet (London, England)
|October 17, 2018
概括
在全球范围内,优化剖腹产的使用至关重要. 解决与妇女,提供者和卫生系统相关的因素是减少不必要的CS出生和改善母亲和婴儿的结果的关键.
科学领域:
- 产科和妇科
- 公共卫生
- 医疗服务研究
背景情况:
- 剖腹产率在全球范围内不断上升,使用过少和使用过多对母亲和产周健康构成风险.
- 目前制不必要的CS使用的干预措施取得了有限的成功,因此需要更深入地了解导致的因素.
- 识别越来越多的CS频率的驱动因素对于开发有效的优化利用策略至关重要.
研究的目的:
- 综合审查影响剖腹产 (剖腹产) 使用的各个层面因素:个人 (妇女,家庭),专业 (卫生服务提供者) 和系统 (组织,医疗保健系统).
- 检查CS的行为,心理,健康系统和财务决定因素.
- 评估旨在减少不必要的CS率的干预措施的有效性.
主要方法:
- 对剖腹产使用和干预的现有文献进行系统审查和综合.
- 分析导致CS使用的因素,包括患者,提供者和卫生系统的影响.
- 评估旨在优化CS率的临床,教育和系统干预措施.
主要成果:
- 在CS之后的临床干预,如外脑版本和阴道分娩,可以减少CS的发生率.
- 在高收入家庭中,助产士带领的护理和分娩伙伴关系与生理分娩的增加,结果的改善和成本的降低有关.
- 解决提供者培训,财务激励,诉讼恐惧,设施资源和领导力的多方面的干预对于优化CS使用至关重要.
结论:
- 减少不必要的剖腹产需要一个全面的,多要素的战略,以适应当地环境.
- 解决妇女和卫生专业人员的担忧以及卫生系统和财务因素至关重要.
- 有效的医疗领导和对培训的投资对于确保CS只在指定的情况下进行至关重要.
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