Dahlen Hannah G, Tracy Sally, Tracy Mark, Bisits Andrew, Brown Chris, Thornton Charlene
Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia.
Royal Hospital for Women, University of Sydney, Sydney, Australia.
BMJ Open. 2014 May 21;4(5):e004551. doi: 10.1136/bmjopen-2013-004551.
To examine the rates of obstetric intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000-2008).
Linked data population-based retrospective cohort study involving five data sets.
New South Wales, Australia.
691 738 women giving birth to a singleton baby during the period 2000-2008.
Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private obstetric units.
Rates of obstetric intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar <7 at 5 min. Neonates born in private hospitals to low-risk mothers were more likely to have a morbidity attached to the birth admission and to be readmitted to hospital in the first 28 days for birth trauma (5% vs 3.6%); hypoxia (1.7% vs 1.2%); jaundice (4.8% vs 3%); feeding difficulties (4% vs 2.4%) ; sleep/behavioural issues (0.2% vs 0.1%); respiratory conditions (1.2% vs 0.8%) and circumcision (5.6 vs 0.3%) but they were less likely to be admitted for prophylactic antibiotics (0.2% vs 0.6%) and for socioeconomic circumstances (0.1% vs 0.7%). Rates of perinatal mortality were not statistically different between the two groups.
For low-risk women, care in a private hospital, which includes higher rates of intervention, appears to be associated with higher rates of morbidity seen in the neonate and no evidence of a reduction in perinatal mortality.
研究2000年至2008年在新南威尔士州公立和私立医院分娩的低风险女性在产后28天内的产科干预率以及相关的围产期死亡率和发病率。
基于关联数据的人群回顾性队列研究，涉及五个数据集。
澳大利亚新南威尔士州。
2000年至2008年期间分娩单胎婴儿的691738名女性。
公立和私立产科单位的新生儿复苏率、围产期死亡率、出生后新生儿入院率以及出生后28天内再次入院率。
私立医院中低风险女性的产科干预率更高，初产妇顺产的可能性比公立医院低20%。私立医院出生的新生儿孕周不足40周的可能性更高；接受某种形式复苏的可能性更大；5分钟时阿氏评分<7分的可能性更小。私立医院中低风险母亲所生的新生儿因出生入院而发病以及在出生后28天内因出生创伤（5%对3.6%）、缺氧（1.7%对1.2%）、黄疸（4.8%对3%）、喂养困难（4%对2.4%）、睡眠/行为问题（0.2%对0.1%）、呼吸道疾病（1.2%对0.8%）和包皮环切术（5.6%对0.3%）再次入院的可能性更大，但因预防性抗生素（0.2%对0.6%）和社会经济状况（0.1%对0.7%）入院的可能性更小。两组围产期死亡率无统计学差异。
对于低风险女性，私立医院的护理（包括更高的干预率）似乎与新生儿更高的发病率相关，且没有证据表明围产期死亡率有所降低。
