Sitaram Bhartia Institute of Science and Research, New Delhi, India.
BJOG. 2015 Jan;122(2):238-47. doi: 10.1111/1471-0528.13054. Epub 2014 Aug 22.
To assess the quality of maternity care in an Indian metropolitan city.
Three-stage cluster randomised cross-sectional survey.
Sixty selected colonies of Delhi.
One thousand eight hundred and one subjects (of 2286 eligible) were enrolled from 118 446 houses. Women who had delivered a live viable birth in the past 6 months were selected for the study.
In stage 1, 20 wards (of 150) were selected using a probability-proportionate-to-size systematic method. In stage 2, one colony from each income stratum (high, middle and low) was selected from each ward by simple random sampling. In stage 3, a house-to-house survey was conducted to recruit 30 women for administering a peer-reviewed and pilot-trialled questionnaire.
Caesarean section rate, induction rate and episiotomy rate.
National health targets such as iron supplementation advice (>96%), tetanus vaccination (>81%), and ≥3 antenatal visits (>90%) were largely achieved across health care facilities but not in home deliveries. Interventions were lower in public than private hospitals: caesarean section [23.7% (20.2-27.7) versus 53.8% (49.3-58.3)], induction [20.6% (17.5-24.25) versus 30.8% (26.8-33.2)] and episiotomy [57.8% (52.3-63.1) versus 79.4% (71.0-85.9)]. Private hospitals achieved better labour support rates [1.1% (0.5-2.2) versus 14.6% (8.5-24.1)] and pain relief [0.9% (0.4-2.0) versus 9.9 (6.5-14.8)]. Pubic hair shaving [16.2% (11.5-22.5) versus 36.4% (29.9-43.4)], enema [20.2% (15.5-26.0) versus 57.3% (49.5-64.8)], and IV fluids during labour [44.0% (36.2-52.2) versus 38.7% (29.3-49.1)] were widely prevalent in public and private hospitals.
Present practices fall short of evidence-based guidelines, with relative overuse of interventions in private hospitals and deficiency of patient-centred practices such as labour support in public hospitals.
评估印度大都市的产妇护理质量。
三阶段整群随机横断面调查。
德里的 60 个选定殖民地。
从 2286 名合格产妇中，选择了 1811 名（118446 户中的 1811 名）产妇。研究纳入了过去 6 个月内分娩过活产儿的妇女。
第 1 阶段，采用概率比例系统方法选择 20 个病房（150 个中的 20 个）。第 2 阶段，从每个病房按收入分层（高、中、低），采用简单随机抽样选择每个收入层的一个殖民地。第 3 阶段，进行逐户调查，招募 30 名妇女，以管理经过同行评审和试点试验的问卷。
剖宫产率、引产率和会阴切开率。
国家卫生目标，如铁补充建议（>96%）、破伤风疫苗接种（>81%）和≥3 次产前检查（>90%），在整个医疗保健机构中基本得到了实现，但在家中分娩时没有实现。干预措施在公立医院中低于私立医院：剖宫产率[23.7%（20.2-27.7）与 53.8%（49.3-58.3）]、引产率[20.6%（17.5-24.25）与 30.8%（26.8-33.2）]和会阴切开率[57.8%（52.3-63.1）与 79.4%（71.0-85.9）]。私立医院的分娩支持率[1.1%（0.5-2.2）与 14.6%（8.5-24.1）]和疼痛缓解率[0.9%（0.4-2.0）与 9.9%（6.5-14.8）]更高。公立医院中，公共和私立医院都广泛存在刮阴毛[16.2%（11.5-22.5）与 36.4%（29.9-43.4）]、灌肠[20.2%（15.5-26.0）与 57.3%（49.5-64.8）]和分娩时静脉输液[44.0%（36.2-52.2）与 38.7%（29.3-49.1）]。
目前的做法不符合循证指南，私立医院过度使用干预措施，而公立医院缺乏以患者为中心的做法，如分娩支持。
