Impact of childbirth policy changes on obstetric workload over a 13-year period in a regional referral center in China - implications on service provision planning.
Impact of childbirth policy changes on obstetric workload over a 13-year period in a regional referral center in China - implications on service provision planning.
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13年来中国地区转诊中心生育政策变化对产科工作量的影响——对服务提供规划的影响
DOI：
10.1186/s12884-021-04074-z
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发表时间：
2021-09-07
影响因子：
3.1
通讯作者：
Ma R
中科院分区：
文献类型：
--
作者：
Xie M;Lao TT;Ma J;Zhu T;Liu D;Yu S;Du M;Sun Q;Ma R
我们的目的是评估自2002年以来国家生育政策的变化，目前允许每个家庭两个孩子，在中国的区域转诊中心产科工作量的影响。在一项回顾性队列研究中，检查了2005-2017年期间与孕产妇人口统计学、高危妊娠妇女发生率和我院管理单胎存活妊娠（胎龄28周以上）的资源统计数据相关的时间变化。在这13年期间，从孕龄28周起的单胎活产人数为49 479人。年出生人数从2005年的1,941人增加到2017年的5,777人。同时，经产妇女的发病率显著增加，（10.6- 50.8%），年龄≥35岁（6.5- 24.3%），有剖腹产史。（2.6- 23.6%），既往终止妊娠≥3次（1.0- 4.9%），患有妊娠前糖尿病（0.2- 0.9%），和患有慢性高血压（0.2- 1.2%）。床位和人员补充量增加，平均住院时间减少。不过，虽然医护人员的工作量随人手增加而保持稳定，但助产士的工作量却显著增加，这可从总分娩人数与助产士的比例由194.1：1上升至320.9：1反映出来（p < 0.001）。在我们医院，随着国家生育政策的修订，每年的分娩数量逐渐增加，高危妊娠妇女的发生率也在增加。只有医务和护理工作人员的增加与工作量相称，但助产士工作人员的增加与工作量不相称。迫切需要采取补救措施，以免预期的护理需求逐步增加，使产妇护理不堪重负，造成潜在的灾难性后果。
We aimed to appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China. In a retrospective cohort study, temporal changes were examined in relation with maternal demographics, incidence of women with high risk pregnancies and resource statistics in our hospital in managing singleton viable pregnancies (birth from 28 weeks gestational age onwards) for the period 2005–2017. During this 13-year period, the number of singleton livebirths from 28 weeks gestational age onwards was 49,479. Annual numbers of births increased from 1,941 to 2005 to 5,777 in 2017. There were concomitant and significant increases in the incidence of multiparous women (10.6–50.8 %), of age ≥35 years (6.5–24.3 %), with prior caesarean Sec. (2.6–23.6 %), with ≥3 previous pregnancy terminations (1.0–4.9 %), with pre-gestational diabetes (0.2–0.9 %), and with chronic hypertension (0.2–1.2 %). There were associated increases in beds and staff complement and reduced average hospital stay. Nevertheless, while the workload of medical staff remained stable with increasing staff complement, that of midwives increased significantly as reflected by the total births: midwife ratio which increased from 194.1:1 to 320.9:1 (p < 0.001). In our hospital, progressively increasing numbers of annual births in combination with an increased incidence of women with high risk pregnancies took place following the revised national childbirth policy. Only the increase in medical and nursing, but not midwifery, staff was commensurate with workload. Remedial measures are urgently required before the anticipated progressive increase in care demand would overwhelm maternity care with potentially disastrous consequences.
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DOI：
10.3760/cma.j.issn.0529-567x.2016.10.008
发表时间：
2016-10-25
期刊：
Zhonghua fu chan ke za zhi
影响因子：
--
作者：
Qu, Z Q;Ma, R M;Zhu, B
通讯作者：
Zhu, B
影响因子：
11.4
作者：
Zhu, Yong-Guan;Ioannidis, John P. A.;Martin, Francis L.
通讯作者：
Martin, Francis L.
DOI：
10.1016/s0140-6736(16)31405-2
发表时间：
2016-10-15
期刊：
Lancet (London, England)
影响因子：
--
作者：
Zeng Y;Hesketh T
通讯作者：
Hesketh T
中国西南部一家三级转诊医院开展审计以减少剖腹产
DOI：
10.2471/blt.11.093369
发表时间：
2012-07-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Runmei, Ma;Terence T, Lao;Dandan, Zhang
通讯作者：
Dandan, Zhang
“忙碌的一天”对周末分娩围产期并发症的影响：一项回顾性队列研究。
影响因子：
5.4
作者：
Snowden JM;Kozhimannil KB;Muoto I;Caughey AB;McConnell KJ
通讯作者：
McConnell KJ