Vogt Sibylle Emilie, Diniz Simone Grilo, Tavares Carlos Mendes, Santos Nagela Cristine Pinheiros, Schneck Camilla Alexsandra, Zorzam Bianca, Vieira Débora de Andrade, Silva Kátia Silveira da, Dias Marcos Augusto Bastos
Universidade Estadual de Montes Claros, Brasil.
Cad Saude Publica. 2011 Sep;27(9):1789-800. doi: 10.1590/s0102-311x2011000900012.
This cross-sectional study of 831 low-risk pregnancies compared the management of labor and delivery in a birthing center, a hospital that had previously won the "Galba de Araújo" Award (for excellence in obstetric and neonatal care), and a standard-protocol maternity facility. The rates for use of ocytocin during labor were 27.9%, 59.5%, and 40.1%, while amniotomy was performed in 67.6%, 73.6%, and 82.2% of the women, respectively. Episiotomy rates were lower in the first two facilities, which have adopted patient-centered obstetric practices (7.2% at the birthing center and 14.8% at the award-winning hospital) as compared to 54.9% at the standard maternity facility. The liberal offer of epidural anesthesia at the awarding-winning hospital resulted in a higher anesthesia rate (54.4%) as compared to the standard facility (7.7%). Forceps delivery and neonatal admission rates were higher in the standard hospital, but there were no differences in mean Apgar or cesarean rates. The findings suggest resistance to selective use of interventions in all three models of obstetric care, although favoring the birthing center as a strategy for controlling interventions during labor and childbirth in low-risk pregnancies, with no resulting harm to the mothers or newborns.
这项针对831例低风险妊娠的横断面研究，比较了分娩中心、一家此前获得过“加尔巴·德·阿劳若奖”（表彰产科和新生儿护理卓越表现）的医院以及一家遵循标准协议的产科机构在分娩管理方面的情况。分娩期间使用催产素的比例分别为27.9%、59.5%和40.1%，而分别有67.6%、73.6%和82.2%的女性接受了人工破膜。前两个采用以患者为中心产科实践的机构，会阴切开术的比例较低（分娩中心为7.2%，获奖医院为14.8%），而标准产科机构的这一比例为54.9%。获奖医院广泛提供硬膜外麻醉，导致其麻醉率（54.4%）高于标准机构（7.7%）。标准医院的产钳助产率和新生儿入院率较高，但平均阿氏评分或剖宫产率没有差异。研究结果表明，在所有三种产科护理模式中，对选择性使用干预措施都存在抵触情绪，尽管倾向于将分娩中心作为控制低风险妊娠分娩期间干预措施的一种策略，且对母亲或新生儿没有造成伤害。
