Quality of care for pregnant women and newborns-the WHO vision.
Quality of care for pregnant women and newborns-the WHO vision.
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DOI：
10.1111/1471-0528.13451
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Bustreo F
中科院分区：
文献类型：
--
作者：
Tunçalp Ӧ;Were WM;MacLennan C;Oladapo OT;Gülmezoglu AM;Bahl R;Daelmans B;Mathai M;Say L;Kristensen F;Temmerman M;Bustreo F
2015年，当我们审查实现千年发展目标的进展情况时，尽管在降低死亡率方面取得了重大进展，但全球孕产妇和新生儿死亡人数仍然高得令人无法接受。在过去十年中，为减少孕妇和新生儿的不良后果所做的努力一直针对增加熟练助产护理。1，2这导致所有地区卫生机构的出生率较高。据报道，在发展中国家，由熟练卫生人员接生的比例从1990年的56%上升到2012年的68%。4.随着保健服务利用率的提高，可避免的产妇和围产期死亡率和发病率中有更大比例的人已转移到保健设施。在这种情况下，许多设施的护理质量差（QoC）成为我们寻求结束可预防的死亡率和发病率的最大障碍。在卫生机构分娩期间的生活质量反映了现有的物质基础设施、用品、管理和人力资源，以及处理怀孕和分娩的知识、技能和能力-正常的生理、社会和文化过程，但容易出现并发症，可能需要及时采取挽救生命的干预措施。研究表明，除了最大限度地扩大基本干预措施的覆盖面之外，还必须加快降低孕产妇和围产期死亡率以及严重发病率。5此外，虐待经历和缺乏支持之间存在复杂的相互作用，影响到妇女的分娩经历和结果。6世界卫生组织（世卫组织）设想，2015年以后，世界上“每个孕妇和新生儿在整个怀孕、分娩和产后期间都能得到优质护理”。这一愿景与世卫组织及其合作伙伴在2013-2014年构想的两个互补的全球行动议程-“消除可预见的孕产妇死亡率战略”和“每个新生儿行动计划”-保持一致。7，8在全球社会为2015年后可持续发展目标时代制定新的《妇女、儿童和青少年健康全球战略》（2016-2030年）的关键时刻阐述了这一点。9虽然产妇死亡的间接原因正在增加（占产妇死亡的27.5%），但在全球范围内，70%以上的产妇死亡是由于怀孕和分娩并发症，如出血、高血压疾病、败血症和堕胎。10早产并发症、出生窒息、产时相关新生儿死亡和新生儿感染加在一起占新生儿死亡率的85%以上。11因此，分娩时间和出生后的这段时间对产妇、胎儿和新生儿的存活和福祉特别重要。在这一关键时期有效预防和管理并发症的护理可能会对减少孕产妇死亡、死产和新生儿早期死亡产生重大影响，这是投资的三重回报。12在这一关键时期，提高护理质量的努力将针对基本的孕产妇和新生儿护理以及管理并发症的额外护理，这可能对孕产妇、胎儿和新生儿的生存和福祉产生最大的影响。根据目前关于负担和影响的证据，以下特定1045 © 2015世界卫生组织;由John Wiley & Sons Ltd代表皇家妇产科医师学院许可。
In 2015, as we review progress towards Millennium Development Goals (MDGs), despite significant progress in reduction of mortality, we still have unacceptably high numbers of maternal and newborn deaths globally. Efforts over the past decade to reduce adverse outcomes for pregnant women and newborns have been directed at increasing skilled birth attendance. 1, 2 This has resulted in higher rates of births in health facilities in all regions. 3 The proportion of deliveries reportedly attended by skilled health personnel in developing countries rose from 56% in 1990 to 68% in 2012. 4 With increasing utilisation of health services, a higher proportion of avoidable maternal and perinatal mortality and morbidity have moved to health facilities. In this context, poor quality of care (QoC) in many facilities becomes a paramount roadblock in our quest to end preventable mortality and morbidity. QoC during childbirth in health facilities reflects the available physical infrastructure, supplies, management, and human resources with the knowledge, skills and capacity to deal with pregnancy and childbirth—normal physiological, social and cultural processes, but prone to complications that may require prompt life-saving interventions. Research shows that it is necessary to go beyond maximising coverage of essential interventions to accelerate reductions in maternal and perinatal mortality and severe morbidity. 5 Moreover, there is a complex interplay of experiences of mistreatment and lack of support that impact women’s childbirth experiences and outcomes. 6 Moving beyond 2015, the World Health Organization (WHO) envisions a world where ‘every pregnant woman and newborn receives quality care throughout pregnancy, childbirth and the postnatal period.’This vision is in alignment with two complementary global action agendas conceptualised by WHO and partners in 2013–2014—’Strategies toward Ending Preventable Maternal Mortality (EPMM)’and ‘Every Newborn Action Plan (ENAP)’. 7, 8 It is articulated at a critical time when the global community is developing the new Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) for the post-2015 Sustainable Development Goal era. 9 Although indirect causes of maternal death are increasing (27.5% of maternal deaths), globally, over 70% of maternal deaths occur as a result of complications of pregnancy and childbirth such as haemorrhage, hypertensive disorders, sepsis and abortion. 10 Complications of preterm birth, birth asphyxia, intrapartum-related neonatal death and neonatal infections together account for more than 85% of newborn mortality. 11 Therefore, the time of childbirth and the period immediately after birth are particularly critical for maternal, fetal and neonatal survival and well-being. Effective care to prevent and manage complications during this critical period is likely to have a significant impact on reducing maternal deaths, stillbirths and early neonatal deaths—a triple return on investment. 12 Within this critical period, quality of care improvement efforts would target essential maternal and newborn care and additional care for management of complications that could achieve the highest impact on maternal, fetal and newborn survival and well-being. Based on the current evidence on burden and impact, the following specific1045© 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.
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