Prual A, De Bernis L, El Joud D Ould
Département d'Information Médicale. Centre Hospitalier de Montluçon, 18, avenue du 8 Mai 1945, 03110 Montluçon Cedex, France.
J Gynecol Obstet Biol Reprod (Paris). 2002 Feb;31(1):90-9.
Prenatal care has been implemented in developing countries according to the same mode as applied in industrialized countries without considering its real effectiveness in reducing maternal and neonatal mortality. Several recent studies suggest that the goals should be revisited in order to implement a program of prenatal care based on real scientific evidence. Based on the current literature, we propose a potentially effective content for prenatal care adapted to the context of developing countries. Four antenatal consultations would be enough if appropriately timed at 12, 26, 32 and 36 weeks pregnancy. The purpose of these consultations would be: 1) to screen for three major risk factors, which, when recognized, lead to specific action: uterine, scare, malpresentation, premature rupture of the membranes; 2) to prevent and/or detect (and treat) specific complications of pregnancy: hypertension, infection (malaria, venereal disease, HIV, tetanus, urinary tract infection); anemia and trace element deficiencies, gestational diabetes mellitus; 3) to provide counseling, support and information for pregnant women and their families (including the partner) concerning: severe signs and symptoms of pregnancy and delivery, community organization of emergency transfer, delivery planning. These potentially effective actions can only have a real public health impact if implemented within an organized maternal health system with a functional network of delivery units, if truly quality care is given, and if the relationships between health care providers and the population are based on mutual respect. Sub-Saharan African women use prenatal care extensively when it is accessible; this opportunity must be used to implement evidence-based actions with appropriate and realistic goals.
发展中国家按照与工业化国家相同的模式实施产前护理，却未考虑其在降低孕产妇和新生儿死亡率方面的实际效果。最近的几项研究表明，应重新审视目标，以便根据真实的科学证据实施产前护理计划。基于当前的文献，我们提出了一种适合发展中国家情况的、可能有效的产前护理内容。如果在怀孕12周、26周、32周和36周时安排得当，四次产前检查就足够了。这些检查的目的是：1）筛查三种主要风险因素，一旦识别出来，就会采取具体行动：子宫异常、瘢痕、胎位不正、胎膜早破；2）预防和/或检测（并治疗）妊娠的特定并发症：高血压、感染（疟疾、性病、艾滋病毒、破伤风、尿路感染）；贫血和微量元素缺乏、妊娠期糖尿病；3）为孕妇及其家人（包括伴侣）提供咨询、支持和信息，内容涉及：妊娠和分娩的严重体征和症状、社区紧急转运组织、分娩计划。这些可能有效的行动只有在一个有组织的孕产妇保健系统内实施，该系统有一个功能正常的分娩单位网络，提供真正高质量的护理，并且医疗保健提供者与人群之间的关系建立在相互尊重的基础上，才能对公共卫生产生真正的影响。撒哈拉以南非洲的妇女在能够获得产前护理时会广泛使用；必须利用这个机会实施基于证据的行动，并设定适当和现实的目标。
