Lutenbacher Melanie, Gabbe Patricia Temple, Karp Sharon M, Dietrich Mary S, Narrigan Deborah, Carpenter Lavenia, Walsh William
Schools of Nursing and Medicine, Vanderbilt University, Nashville, TN, USA,
Matern Child Health J. 2014 Jul;18(5):1142-54. doi: 10.1007/s10995-013-1344-4.
Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. Single site randomized clinical trial. Eligibility: >18 years with prior live birth ≥20-<37 weeks gestation; <24 weeks gestation at enrollment; spoke and read English; received care at regional medical center. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age 27.8 years; mean gestational age at enrollment was 15 weeks. Racial breakdown mirrored local demographics. Most had a partner, high school education, and 62% had Medicaid. No statistically significant group differences were found in gestational age at birth. Intervention participants had a shorter intrapartum length of stay. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB.
有早产史的女性再次早产的可能性很高。一些导致早产的风险因素和健康行为可能适合进行干预。家庭访视是一种提供循证干预措施的很有前景的方法。我们评估了一种旨在降低有早产史孕妇样本的早产率和住院时间的护理系统。单中心随机临床试验。入选标准：年龄>18岁，既往有孕20至<37周的活产史；入组时孕周<24周；会说英语和读英语；在地区医疗中心接受护理。所有参与者（N = 211）均接受标准的产前护理。干预组参与者（N = 109）还接受了由认证助产士进行的家庭访视，访视遵循针对特定风险因素（如抑郁症状、虐待、吸烟）的方案。数据通过多种方法和来源收集，包括干预保真度评估。平均年龄27.8岁；入组时平均孕周为15周。种族分布反映了当地人口统计学特征。大多数人有伴侣，接受过高中教育，62%有医疗补助。出生时的孕周在两组间未发现统计学上的显著差异。干预组参与者的产时住院时间较短。由助产士进行家庭访视的强化产前护理可能会限制一些风险因素，并缩短有早产史女性的产时住院时间。本研究有助于了解针对与早产相关的风险因素的循证家庭访视干预措施。
