Rana T Geetha, Rajopadhyaya Rashmi, Bajracharya Binod, Karmacharya Manju, Osrin David
Women's Health Project, UNICEF Nepal, UK.
Health Policy Plan. 2003 Sep;18(3):330-7. doi: 10.1093/heapol/czg039.
To evaluate Nepal's first independent midwifery unit, the Patan Hospital Birthing Centre (BC), as a model for training and service provision for low risk deliveries. Specifically, to compare its efficacy with that of an adjacent Consultant-led Maternity Unit (CMU).
Unpaired comparison of delivery procedures and outcomes at the Patan Hospital, Lalitpur. The sample was 988 women (550 at BC, 438 at CMU). Women judged to be at low risk of complications were enrolled at delivery at each facility. Information was collected by standardized interviews and record review. Main outcome measures were incidence of complications of labour, technical procedures and access to postnatal care and family planning services.
Artificial rupture of membranes was more likely to be performed at the BC (RR 1.26, 95% CI 1.10-1.44). Augmentation of labour with oxytocin was less likely to be performed (RR 0.26, 95% CI 0.20-0.33), as was episiotomy (RR 0.64, 95% CI 0.57-0.72). The incidence of oxytocic augmentation was high at the CMU (205/438: 46.9%). The incidence of moderately or thickly meconium-stained liquor was lower at the BC than at the CMU (RR 0.62, 95% CI 0.43-0.91), a finding that was associated with oxytocic augmentation of labour. No significant differences were found for duration or complications of labour, mode of delivery, birth weight, neonatal Apgar score or admission to the special care baby unit. Women delivering at the BC were more likely to attend both postnatal (RR 1.33, 95% CI 1.18-1.51) and family planning clinics (RR 1.85, 95% CI 1.44-2.38).
After appropriate screening, intrapartum care for low risk deliveries is effectively provided by midwives. The Birthing Centre model should be considered throughout the developing world, particularly as a site for training of skilled attendants.
评估尼泊尔首个独立助产单元——帕坦医院分娩中心（BC），将其作为低风险分娩培训及服务提供的典范。具体而言，将其疗效与相邻的由顾问主导的产科病房（CMU）进行比较。
对加德满都帕坦医院的分娩程序及结果进行非配对比较。样本为988名女性（BC组550名，CMU组438名）。在每家机构分娩时，纳入判定为并发症低风险的女性。通过标准化访谈及记录审查收集信息。主要结局指标为产程并发症发生率、技术操作以及产后护理和计划生育服务的可及性。
BC组更有可能进行人工破膜（相对危险度1.26，95%可信区间1.10 - 1.44）。使用缩宫素加强宫缩的可能性较小（相对危险度0.26，95%可信区间0.20 - 0.33），会阴切开术亦是如此（相对危险度0.64，95%可信区间0.57 - 0.72）。CMU组缩宫素加强宫缩的发生率较高（205/438：46.9%）。BC组羊水Ⅱ度或Ⅲ度胎粪污染的发生率低于CMU组（相对危险度0.62，95%可信区间0.43 - 0.91），这一发现与使用缩宫素加强宫缩有关。在产程时长或并发症、分娩方式、出生体重、新生儿阿氏评分或入住特殊护理婴儿病房方面未发现显著差异。在BC组分娩的女性更有可能前往产后护理（相对危险度1.33，95%可信区间1.18 - 1.51）和计划生育诊所（相对危险度1.85，95%可信区间1.44 - 2.38）。
经过适当筛查后，助产士可有效提供低风险分娩的产时护理。分娩中心模式应在整个发展中世界予以考虑，尤其是作为培训熟练助产人员的场所。
