医生和助产士如何处理分娩的第三阶段？

How do physicians and midwives manage the third stage of labor?

作者信息

Tan Weiping M, Klein Michael C, Saxell Lee, Shirkoohy Sahba Eftekhary, Asrat Getnet

机构信息

Private Practice, Coquitlam, British Columbia, Canada.

出版信息

Birth. 2008 Sep;35(3):220-9. doi: 10.1111/j.1523-536X.2008.00243.x.

DOI:10.1111/j.1523-536X.2008.00243.x

PMID:18844648

Abstract

BACKGROUND

Current practice guidelines recommend active management of the third stage of labor. We compared practices of three maternity care provider disciplines in management of third-stage labor and the justifications for their approach.

METHODS

This study is a cross-sectional survey of maternity practitioners in usual practice settings in British Columbia. All 199 obstetricians, all 82 midwives, and a random sample of family physicians practicing intrapartum maternity care (one-third, or 346) were surveyed The three main outcome measures by discipline were the method preferred in managing third-stage labor, the reasons given for the chosen method, and views on the appropriateness of the current third-stage labor guideline.

RESULTS

The overall response rate was 57.8 percent. Response rates indicating that the participants were "aware of guideline" were the following: obstetricians, 85.3 percent; family physicians, 53.7 percent; and midwives, 97.8 percent. Response rates indicating that the participants "agreed with guideline" were the following: obstetricians, 95.2 percent; family physicians, 97.6 percent; and midwives, 51.2 percent. Response rates indicating that "oxytocin should be given with anterior shoulder" were the following: obstetricians, 71.1 percent; family physicians, 68.3 percent; and midwives, 26.7 percent. Response rates indicating that "routine active management of third stage of labor should be the norm" were the following: obstetricians, 79.2 percent; family physicians, 60.2 percent; and midwives, 17 percent. All results were statistically significant (p < 0.01).

CONCLUSIONS

A major difference was found between physicians and midwives in the management of third-stage labor. Physicians routinely implemented active management of the third stage of labor; midwives preferred expectant approaches, principally based on women's preference. Provincial data did not show differences in postpartum hemorrhage or transfusion rates by practitioner type.

摘要

背景

当前的实践指南推荐对第三产程进行积极管理。我们比较了三类产科护理提供者在第三产程管理方面的做法及其采取该方法的理由。

方法

本研究是对不列颠哥伦比亚省常规执业环境中的产科从业者进行的横断面调查。对所有199名产科医生、所有82名助产士以及随机抽取的从事产时产科护理的家庭医生样本（三分之一，即346名）进行了调查。按专业划分的三项主要结果指标为：第三产程管理中首选的方法、选择该方法的理由以及对当前第三产程指南适当性的看法。

结果

总体回复率为57.8%。表示“知晓指南”的回复率如下：产科医生为85.3%；家庭医生为53.7%；助产士为97.8%。表示“同意指南”的回复率如下：产科医生为95.2%；家庭医生为97.6%；助产士为51.2%。表示“应在胎头前肩娩出时给予缩宫素”的回复率如下：产科医生为71.1%；家庭医生为68.3%；助产士为26.7%。表示“第三产程常规积极管理应成为规范”的回复率如下：产科医生为79.2%；家庭医生为60.2%；助产士为17%。所有结果均具有统计学意义（p<0.01）。