Hiraizumi Yoshie, Suzuki Shunji
Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital.
J Obstet Gynaecol Res. 2013 Nov;39(11):1500-4. doi: 10.1111/jog.12094. Epub 2013 Jul 15.
It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan.
A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, <7). Analysis was by intention to treat.
The incidence of transfer from primary midwife-led care to obstetric shared care was 27% (77 women) mainly due to failure of labor progress (21%, 16 women), postpartum hemorrhage (19%, 15 women) and non-reassuring fetal status (19%, 15 women). Significantly higher incidence of transfer to obstetric shared care from primary midwife-led care was seen among women who chose hospital delivery compared with women who chose home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery).
Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan.
在日本，由初级助产士主导护理的计划在家分娩和计划在医院分娩是否会增加低风险女性发生不良事件的风险，这方面尚未得到广泛研究。
进行了一项回顾性队列研究，以比较291名在分娩期间接受初级助产士主导护理的女性与217名接受标准产科共享护理的女性的围产期结局。在291名接受初级助产士主导护理的女性中，分别有168名和123名选择在家分娩和在医院分娩。围产期结局包括产程时长达到或超过24小时、产痛加剧、分娩方式、严重会阴裂伤、产后出血达到或超过1000毫升、产妇发热达到或超过38°C以及新生儿窒息（阿氏评分<7）。分析采用意向性治疗。
从初级助产士主导护理转为产科共享护理的发生率为27%（77名女性），主要原因是产程进展失败（21%，16名女性）、产后出血（19%，15名女性）和胎儿状况不佳（19%，15名女性）。与选择在家分娩的女性相比，选择在医院分娩的女性从初级助产士主导护理转为产科共享护理的发生率显著更高（34%对21%，P = 0.011）。接受产科共享护理的女性和接受初级助产士主导护理的女性（无论在家分娩还是在医院分娩）之间，不良围产期结局的发生率没有显著差异。
约四分之一接受初级助产士主导护理的低风险女性在分娩期间或产后需要产科护理。然而，在日本，低风险孕妇在家中和医院由初级助产士主导护理与不良围产期结局无关。
