医院产科体积和母亲的结果:医院的大小是否重要?
Natalie Holowko1,2, Linnea V Ladfors1, Anne K Örtqvist1,3
1Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Acta obstetricia et gynecologica Scandinavica
|November 18, 2024
概括
产科病房关闭并没有对孕产妇的结果产生很大的影响. 虽然较小的单位显示出产后出血 (PPH) 的几率降低,但分娩开始和产科关节损伤 (OASIS) 与医院体积没有显著相关.
科学领域:
- 产科 产科 产科 产科 产科
- 孕产妇健康 孕产妇健康
- 医疗保健管理的管理
背景情况:
- 医疗保健的集中化导致产科病房关闭.
- 有证据表明,在更大的设施中,婴儿的结果更好,但对母亲的结果的研究较少.
- 这项研究调查了产科单位关闭和医院容量对孕产妇结果的影响.
研究的目的:
- 检查产科体积和分娩开始之间的关联.
- 为了研究产科体积和产后出血 (PPH) 之间的关系.
- 确定产科体积是否与产科关节损伤 (OASIS) 有关.
主要方法:
- 分析了瑞典近300万个出生 (1992-2019) 与人口统计和诊断数据相关的数据.
- 产科产量分为低 (0-1999),中 (2000-3999) 和高 (≥4000个出生/年).
- 多级物流模型用于估计与医院体积相关的分娩开始,PPH和OASIS的几率比率.
主要成果:
- 在不同的医院体积中,分娩开始 (自发与诱导/选择性剖腹产) 没有显著差异.
- 与高体积医院相比,在低和中体积医院观察到更低的产后出血 (PPH) 几率.
- 产科体积和产科关节损伤 (OASIS) 之间没有发现显著的关联.
结论:
- 产科体积与分娩开始或OASIS没有强烈的关联.
- 较小单位的PPH几率降低可能是由于高风险怀孕被转移到更大的设施.
- 进一步的研究应该探索与产科单位关闭有关的工作量和拥挤等因素.
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