CONTINUITY OF CARE BY A MIDWIFE TEAM VERSUS ROUTINE CARE DURING PREGNANCY AND BIRTH - A RANDOMIZED TRIAL
CONTINUITY OF CARE BY A MIDWIFE TEAM VERSUS ROUTINE CARE DURING PREGNANCY AND BIRTH - A RANDOMIZED TRIAL
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DOI：
10.5694/j.1326-5377.1995.tb124592.x
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发表时间：
1995-09-18
影响因子：
11.4
通讯作者：
WLODARCZYK, JH
中科院分区：
文献类型：
--
作者：
ROWLEY, MJ;HENSLEY, MJ;WLODARCZYK, JH
目的：比较助产士团队的护理连续性与不同医生和助产士的常规护理。设计：一项分层、随机对照试验。参与者和环境：814 名在三级转诊大学医院的产前诊所就诊的妇女。干预：妇女被随机分配到由六名助产士组成的团队中的团队护理，或由不同医生和助产士提供的常规护理。主要结果指标：产前、产时和新生儿事件；产妇满意度；结果：405 名女性被随机分配到团队护理，409 名女性被分配到常规护理；他们分别接生了 385 名和 386 名婴儿。团队护理女性更有可能参加产前课程（OR，1.73；95% CI，1.23-2.42）；分娩期间使用哌替啶的可能性较小（OR，0.32；95% CI，0.22-0.46）；更有可能在没有干预的情况下分娩（OR，1.73；95% CI，1.28-2.34）。团队护理母亲的婴儿接受的新生儿复苏较少（OR，0.59；95% CI，0.41-0.86），尽管五分钟时的 Apgar 评分没有差异（OR，0.86；95% CI，0.29-2.57）。两组单胎妊娠母亲的死产和新生儿死亡率相同（死亡 3 例），但接受团队护理的双胎妊娠母亲有 3 例死亡（出生体重为 600 克、660 克、1340 克）。在孕产妇满意度的所有指标上，团队护理的评价均优于常规护理。团队护理意味着成本降低了 4.5%。结论：由助产士小团队提供的连续护理可以以比常规护理更低的成本带来更令人满意的分娩体验，并且减少不良孕产妇和新生儿结局。尽管需要进行更大规模的研究才能提供足够的能力来检测罕见的结果，但研究发现助产士团队的连续护理与常规护理一样安全。
Objective: To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives.Design: A stratified, randomised controlled trial.Participants and setting: 814 women attending the antenatal clinic of a tertiary referral, university hospital.Intervention: Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives.Main outcome measures: Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment.Results: 405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% CI, 1.23-2.42); less likely to use pethidine during labour (OR, 0.32; 95% CI, 0.22-0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% CI, 1.28-2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% CI, 0.41-0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% CI, 0.29-2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%.Conclusion: Continuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, out study found that continuity of care by a midwife team was as safe as routing care.