分娩第三阶段的护理政策：叙利亚产科病房调查。
Policies for care during the third stage of labour: a survey of maternity units in Syria.
机构信息
North Middlesex University Hospital NHS Trust, Academic Foundation Trainee, Sterling Way, London N18 1QX, UK.
出版信息
BMC Pregnancy Childbirth. 2010 Jun 22;10:32. doi: 10.1186/1471-2393-10-32.
BACKGROUND
Care for women during the third stage aims to reduce the risk of major haemorrhage, but is very variable. The current World Health Organisation (WHO) recommendation is that care should include administration of a uterotonic (oxytocin, if it is available) soon after birth of the baby, delayed cord clamping, and delivery of the placenta by controlled cord traction.
METHODS
To ascertain care policies used during the third stage of labour in maternity units in Syria, we conducted a survey of 69 maternity units in obstetric and general public hospitals. A brief questionnaire was administered by face to face interview or telephone with senior obstetricians and midwives. Outcome measures were the use of prophylactic uterotonic drugs, timing of cord clamping, use of controlled cord traction, and treatment for postpartum haemorrhage. Obstetricians were asked about both vaginal and caesarean births, midwives only about vaginal births.
RESULTS
Responses were obtained for 66 (96%) hospitals: a midwife and an obstetrician were interviewed in 40; an obstetrician only in 20; a midwife only in 6. Responses were similar, although midwives were more likely to report that the umbilical cord was clamped after 1-3 minutes or after cessation of pulsation (2/40 obstetricians and 9/40 midwives). Responses have therefore been combined.One hospital reported never using a prophylactic uterotonic drug. The uterotonic was Syntometrine(R) (oxytocin and ergometrine) in two thirds of hospitals; given after delivery of the placenta in 60 (91%) for vaginal births, and in 47 (78%) for caesarean births. Cord clamping was within 20 seconds at 42 hospitals 64%) for vaginal births and 45 (75%) for caesarean births. Controlled cord traction was never used in a quarter (17/66) of hospitals for vaginal births and a half (32/60) for caesarean births.68% of respondents (45/66) thought there was a need for more randomised trials of interventions during the third stage of labour.
CONCLUSION
Most maternity units report using Syntometrine(R), usually given after delivery of the placenta, clamping the cord within 20 seconds, and using controlled cord traction.
背景
分娩第三阶段的护理旨在降低大出血的风险，但护理措施差异很大。目前，世界卫生组织（WHO）的建议是，在婴儿出生后应立即给予子宫收缩剂（如果有缩宫素）、延迟脐带夹闭，并通过控制脐带牵引娩出胎盘。
方法
为了确定叙利亚产科单位在分娩第三阶段使用的护理政策，我们对 69 家产科和综合公立医院进行了调查。由资深产科医生和助产士通过面对面访谈或电话进行了简短的问卷调查。主要结局指标是预防性使用子宫收缩剂、脐带夹闭时间、使用控制性脐带牵引以及产后出血的治疗。产科医生被问到阴道分娩和剖宫产分娩的情况，助产士只问到阴道分娩的情况。
结果
有 66 家（96%）医院回复了调查：40 家医院由一名助产士和一名产科医生接受访谈；20 家医院仅由一名产科医生接受访谈；6 家医院仅由一名助产士接受访谈。回复结果相似，尽管助产士更可能报告脐带在 1-3 分钟后或在搏动停止后夹闭（40 名产科医生中有 2 名，40 名助产士中有 9 名）。因此，这些回复被合并。一家医院报告从未使用预防性子宫收缩剂。有三分之二的医院使用欣母沛（缩宫素和麦角新碱）；60 家（91%）阴道分娩和 47 家（78%）剖宫产分娩的胎盘娩出后使用。42 家（64%）阴道分娩和 45 家（75%）剖宫产分娩的脐带夹闭在 20 秒内。四分之一（17/66）的医院在阴道分娩中从未使用控制性脐带牵引，一半（32/60）的医院在剖宫产分娩中从未使用。68%的受访者（45/66）认为有必要进行更多关于分娩第三阶段干预措施的随机试验。
结论
大多数产科单位报告使用欣母沛，通常在胎盘娩出后使用，脐带夹闭在 20 秒内，并且使用控制性脐带牵引。
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