经过剖腹产分娩的妇女周产发病率 (PRISMA试验):一个集群随机试验
Nils Chaillet1, Benoît Mâsse2, William A Grobman3
1CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada.
Lancet (London, England)
|December 14, 2023
概括
一项新的干预措施改善了先前剖腹产的妇女的决策, 显著降低了重大产周和产妇病率. 这种方法支持明智的选择,而不会增加剖腹产或子宫破裂率.
科学领域:
- 产科和妇科
- 产妇和胎儿医学
- 公共卫生干预措施
背景情况:
- 经过剖腹产的妇女在随后的怀孕中面临着复杂的选择.
- 重复剖腹产和剖腹产后阴道分娩 (VBAC) 都带有潜在的孕产妇和产周风险.
- 优化决策和护理实践对于改善这一群体的结果至关重要.
研究的目的:
- 评估一项旨在支持以人为中心的决策和最佳实践的多方面的干预措施,
- 确定该干预措施是否可以降低重症周围疾病的风险.
主要方法:
- 一个多中心,集群随机,受控的试验,涉及北克的40家医院.
- 医院被随机分配到干预组 (最佳实践,决策支持工具) 或对照组 (没有干预).
- 主要结局是对21281名妇女的综合性患者病率的分析.
主要成果:
- 与对照组相比,干预组的重症周围发病率显著降低 (调整后OR为0. 72, p=0. 042).
- 在干预组中,主要的孕产妇发病率也显著降低 (调整后OR为0. 54, p=0. 016).
- 剖腹产和子宫破裂的发生率在两组之间没有显著差异.
结论:
- 促进知情决策和最佳实践的多方面的干预措施可以显著降低先前剖腹产的妇女的重大产前和产后病率.
- 这种方法在改善结果方面是有效的,而不会对剖腹产或子宫破裂的比例产生不利影响.
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