Tucker J, Parry G, Penney G, Page M, Hundley V
Dugald Baird Centre for Research on Women's Health, Department of Obstetrics and Gynaecology, University of Sheffield, UK.
Paediatr Perinat Epidemiol. 2003 Oct;17(4):369-77. doi: 10.1046/j.1365-3016.2003.00524.x.
Evidence for staffing recommendations in labour wards is scant. This study aimed to test association between midwife workload with adjusted process of continuous electronic fetal monitoring (CEFM) and neonatal outcome indicators. This was a prospective workload study in 23 consultant-led labour wards in Scotland. There were 3489 livebirths during September 2000, and 1561 consecutively delivered women with CEFM case review during the mid-two weeks. Process measures were: adjusted rates of CEFM, appropriate CEFM, and time to medical response for a serious fetal heart trace abnormality. Neonatal outcome indicators were: Apgar score < 7 at 5 minutes, admission to neonatal unit (NNU) > 48 hours, and neonatal resuscitation. Complete information was available for 99% (2553/2576) of workload time points, 99% (1559) of CEFM process, and 3083 eligible neonates. There were no associations between occupancy or staffing ratios and adjusted CEFM process, Apgar < 7 at 5 minutes (0.98 [0.83, 1.15]) or admission to NNU for > 48 hours (0.97 [0.95, 1.00]). However, there was association between increasing staffing ratios and lower odds of adjusted neonatal resuscitation (excluding bag and mask only) (0.97 [0.94, 0.99]). The direction of effect of increasing workload suggests detriment to outcome indicators, although the size of effect may be small.
关于产房人员配置建议的证据很少。本研究旨在测试助产士工作量与连续电子胎儿监护（CEFM）调整过程及新生儿结局指标之间的关联。这是一项在苏格兰23个由顾问主导的产房进行的前瞻性工作量研究。2000年9月有3489例活产，在中间两周有1561例连续分娩的妇女接受了CEFM病例审查。过程指标包括：CEFM调整率、适当的CEFM以及对严重胎儿心率异常的医疗反应时间。新生儿结局指标包括：5分钟时阿氏评分<7分、入住新生儿重症监护病房（NNU）超过48小时以及新生儿复苏。99%（2553/2576）的工作量时间点、99%（1559）的CEFM过程以及3083例符合条件的新生儿有完整信息。床位占用率或人员配置比例与调整后的CEFM过程、5分钟时阿氏评分<7分（0.98[0.83，1.15]）或入住NNU超过48小时（0.97[0.95，1.00]）之间没有关联。然而，人员配置比例增加与调整后新生儿复苏（不包括仅使用气囊面罩）几率降低之间存在关联（0.97[0.94，0.99]）。工作量增加的影响方向表明对结局指标不利，尽管影响大小可能较小。
