前进一步:实施和评估STEPS计划,以优化在阴道分娩中优化产后出血管理
Pei Zhang1, Yifan Fan1, Hui Song1
1School of Medicine, Nankai University, Tianjin, China (Zhang, Fan, Song, Geng, Cui, Jia and Chen); Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (Zhang, Fan, Lv, Song, Geng, Ma, Cui, Jia and Chen); Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China (Zhang, Fan, Song, Geng, and Chen).
American journal of obstetrics & gynecology MFM
|December 15, 2024
概括
提高分娩安全的策略和工具 (STEPS) 计划改善了通过阴道分娩的产后出血 (PPH) 管理. 它提高了风险识别,减少了输血和住院时间,这对母亲的安全至关重要.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇健康 孕产妇健康
- 公共卫生 公共卫生
背景情况:
- 产后出血 (PPH) 是全球主要的孕产妇死亡原因,特别是在资源有限的地区.
- 优化护理,监测和干预措施是提高阴道分娩期间母亲安全的关键.
- 将这些策略整合到日常的阴道分娩护理中需要进一步的探索.
研究的目的:
- 评估提高分娩安全策略和工具 (STEPS) 计划对产后出血 (PPH) 管理的影响和可持续性.
- 评估PPH发病率的变化,严重的PPH率,以及在STEPS实施后的相关干预措施.
主要方法:
- 一项前后研究比较了从2020年1月到2023年11月的阴道分娩.
- 2022年1月启动的STEPS计划包括增强的围产期护理包,跨学科培训和使用统计过程控制 (SPC) 工具的持续监测.
- 主要结局是PPH发生率 (在24小时内损失≥500毫升血液).
主要成果:
- 在STEPS后,PPH发病率略有增加 (11.1%对11.8%),但严重的PPH发病率保持不变.
- 观察到PPH患者的输血 (aRR,0.77) 和住院时间显著减少.
- 被确定为高风险分娩前PPH患者的比例在STEPS后显著增加 (P<.001).
结论:
- 通过改善风险识别和有针对性的干预措施,STEPS计划增强了PPH管理.
- 步骤导致减少了输血率,并缩短了PPH妇女的住院时间.
- 综合风险评估,监测和定制干预措施的综合方法对于阴道分娩的PPH管理至关重要,特别是在资源有限的环境中.
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