Suzuki Shunji, Hiraizumi Yoshie, Satomi Misao, Miyake Hidehiko
Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan.
J Matern Fetal Neonatal Med. 2011 Aug;24(8):1046-50. doi: 10.3109/14767058.2010.545912. Epub 2011 Jan 13.
To examine the obstetric outcomes of our 'low risk' pregnant women under the midwife-led delivery care compared with those under the obstetric shared care.
A retrospective cohort study compared outcomes of labor under midwife 'primary' care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH. In this study, pregnant women were initially considered 'low risk' at admission when they had no history of medical, gynecological, or obstetric problems and no complications during the present pregnancy.
There were 1031 pregnant women initially considered 'low risk' at admission. At admission, 878 of them (85%) requested to give birth under midwife care; however 364 of these women (42%) were transferred to obstetric shared care during labor. The average length of labor under the midwife 'primary' care was significantly longer than that under the obstetric shared care. However, there were no significant differences in the rate of prolonged labor (≥24 h). There were no significant differences in other obstetric or neonatal outcomes between the two groups.
There was no evidence indicating that midwife 'primary' care is unsafe for 'low risk' pregnant women. Therefore, midwifery care is recommended for 'low risk' pregnant women.
比较在助产士主导的分娩护理下与产科共同护理下，我们“低风险”孕妇的产科结局。
一项回顾性队列研究比较了助产士“主要”护理下的分娩结局与产科共同护理下的分娩结局。所检查的因素包括：产妇年龄、产次、分娩时的孕周、产程长度、产痛增强、分娩方式、会阴切开术、会阴裂伤、产后出血、新生儿出生体重、阿氏评分和脐动脉pH值。在本研究中，孕妇入院时若没有内科、妇科或产科问题病史且本次妊娠期间无并发症，则最初被视为“低风险”。
有1031名孕妇入院时最初被视为“低风险”。入院时，其中878名（85%）要求在助产士护理下分娩；然而，这些妇女中有364名（42%）在分娩期间被转至产科共同护理。助产士“主要”护理下的平均产程明显长于产科共同护理下的平均产程。然而，产程延长（≥24小时）的发生率没有显著差异。两组之间在其他产科或新生儿结局方面没有显著差异。
没有证据表明助产士“主要”护理对“低风险”孕妇不安全。因此，建议对“低风险”孕妇采用助产护理。
