Optimizing Postpartum Care
Optimizing Postpartum Care
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DOI：
10.1097/aog.0000000000002633
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发表时间：
2018-05-01
影响因子：
7.2
通讯作者：
Gulati, Martha
中科院分区：
文献类型：
--
作者：
Stuebe, Alison;Auguste, Tamika;Gulati, Martha
出生后的几周对妇女和婴儿来说是一个关键时期，为长期健康和福祉奠定了基础。为了优化妇女和婴儿的健康，产后护理应成为一个持续的过程，而不是一个单一的遭遇，提供针对每个妇女个人需求的服务和支持。建议所有妇女在产后前3周内与妇产科医生或其他产科护理提供者联系。在进行初步评估后，应根据需要进行持续护理，最后在出生后12周内进行全面的产后访视。全面的产后访视应包括对身体、社会和心理健康的全面评估，包括以下领域：情绪和情感健康;婴儿护理和喂养;性、避孕和生育间隔;睡眠和疲劳;出生后的身体恢复;慢性病管理;和健康维护。对于患有慢性疾病（如高血压疾病、肥胖症、糖尿病、甲状腺疾病、肾脏疾病和情绪障碍）的妇女，应告知其妇产科医生或初级保健提供者及时随访的重要性，以持续协调护理。在产后期间，妇女和她的妇产科医生或其他产科护理提供者应确定谁将承担主要责任，她在她的初级医疗之家的持续护理的卫生保健提供者。优化对产后家庭的护理和支持需要政策变革。产后护理范围的变化应通过支持产后护理作为一个持续过程而不是孤立的访问的报销政策来促进。妇产科医生和其他产科护理提供者应站在政策努力的前列，使所有妇女都能从分娩中康复并养育婴儿。本委员会的意见已经修订，以加强“第四个三个月”的重要性，并提出了一个新的模式，产后护理。
The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders should be counseled regarding the importance of timely follow-up with their obstetrician-gynecologists or primary care providers for ongoing coordination of care. During the postpartum period, the woman and her obstetrician-gynecologist or other obstetric care provider should identify the health care provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit. Obstetrician-gynecologists and other obstetric care providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants. This Committee Opinion has been revised to reinforce the importance of the "fourth trimester" and to propose a new paradigm for postpartum care.