Department of Obstetrics/Gynecology, Central Hospital, Västerås SE-721 89, Sweden.
Acta Obstet Gynecol Scand. 2010;89(2):230-7. doi: 10.3109/00016340903479894.
To describe the process of change and assess compliance and effect on maternal and infant outcome when the WHO package Effective Perinatal Care (EPC) was implemented at maternities in Ukraine.
Intervention study comparing outcomes before and during 2.5 years after training.
Three maternities in Donetsk, Lutsk and Lviv 2003-2006.
Baseline data were collected for 652, 742 and 302 deliveries and 420, 381 and 135 infants, respectively, in Donetsk, Lutsk and Lviv. Follow-up data included 4,561, 9,865 and 7,227 deliveries and 3,829, 8,658 and 6,401 infants.
Staff training on evidence-based guideline.
Interventions during labor, maternal outcomes and hypothermia in the infants.
EPC procedures were successfully implemented and adherence to the protocols was excellent. For most variables, the change occurred during the first three months but was well sustained. The use of partogram increased fourfold in Donetsk and from 0% to 60% in Lviv. Induction and augmentation of labor decreased to less than 1% and less than 5%, respectively. Cesarean section rate dropped significantly in two of the maternities. The proportion of hypothermic infants decreased from 60% (Donetsk), 85% (Lutsk) and 77% (Lviv) to 1% in all three maternities during the first three months and was stable throughout the study period. Admission to Neonatal Intensive Care Unit decreased significantly in two of the maternities and there was no effect on early neonatal mortality.
The process of education and change was well anchored in the organization, and implementation of new procedures was quick and successful.
描述在乌克兰产科实施世卫组织有效围产保健包（EPC）时的变革过程，并评估其对母婴结局的依从性和效果。
培训前后 2.5 年进行干预研究，比较结局。
2003-2006 年在顿涅茨克、卢茨克和利沃夫的三家产科医院。
顿涅茨克、卢茨克和利沃夫的基线数据分别收集了 652、742 和 302 例分娩和 420、381 和 135 例婴儿，随访数据包括 4561、9865 和 7227 例分娩和 3829、8658 和 6401 例婴儿。
对工作人员进行基于证据的指南培训。
分娩期间的干预措施、产妇结局和婴儿低体温。
EPC 程序得到成功实施，对方案的依从性极好。对于大多数变量，变化发生在头三个月内，但维持良好。产程图的使用在顿涅茨克增加了四倍，在利沃夫从零增加到 60%。引产和催产分别减少到不到 1%和不到 5%。两家产科医院的剖宫产率显著下降。在头三个月内，所有三家医院的婴儿低体温比例从 60%（顿涅茨克）、85%（卢茨克）和 77%（利沃夫）降至 1%，并在整个研究期间保持稳定。两家产科医院新生儿重症监护病房的入院率显著下降，早期新生儿死亡率没有影响。
教育和变革过程在组织中得到很好的巩固，新程序的实施迅速而成功。
