在分娩期间进行干预的同意:基于全国人口的研究
Marianne Jacques1, Anne Alice Chantry1,2, Anne Evrard3
1Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France.
概括
在分娩期间的医疗干预,包括催产素,表皮切割和紧急剖腹产,经常在未经妇女知情同意的情况下进行. 改善沟通和促进分娩计划对于提高患者参与分娩决策至关重要.
科学领域:
- 产科和妇科 产科和妇科
- 患者权利 患者权利
- 公共卫生 公共卫生
背景情况:
- 知情同意是道德医疗实践的基石,特别是在分娩期间.
- 了解患病率和影响干预缺乏同意的因素对于改善孕产妇保健至关重要.
- 之前的研究已经突出了有关产科护理患者自主权的担忧.
研究的目的:
- 确定在未经妇女同意的情况下在分娩期间进行的医疗干预的人口水平频率.
- 为了确定与未能获得同意的干预措施相关的孕产妇,产科和组织因素,如催产素的管理,表皮切割和紧急剖腹产.
- 为改善劳动和分娩期间的沟通和患者参与决策提供证据.
主要方法:
- 一项全国性的横截面研究,Enquête Nationale Périnatale 2021,包括法国大都会地区7394名妇女的代表样本,经过2个月的分娩后随访.
- 该研究计算了未经同意进行的干预 (催产素,表皮切割,紧急剖腹产) 的率和置信区间.
- 强大的差异 波桑回归,对缺少的数据进行多次归算,并对磨损进行加权,用于评估具有各种特征的关联.
主要成果:
- 很大一部分女性报告说缺乏同意:44.7%的催产素,60.2%的表皮切割,36.6%的紧急剖腹产.
- 缺乏对催产素的同意与母亲在国外分娩,低教育和晚期宫扩张有关;计划生育与更高的同意率有关.
- 产科医生的协助增加了对表皮切割缺乏同意的可能性,而对胎儿痛苦的剖腹产与未能获得对该程序的同意有关.
结论:
- 围产专业人员经常无法获得在分娩期间进行干预的同意,这会影响妇女的自主权.
- 重组护理,加强沟通培训和促进分娩计划对于改善妇女参与决策至关重要.
- 解决这些问题对于维护患者权利和提高产科护理质量至关重要.
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