Quispel Chantal, Lambregtse-van den Berg Mijke, Kaan Marjolein, van den Berg P Mirelle, Hoogendijk Witte J G, Steegers Eric A P, Koudstaal Thamar, Muis Inge, Bonsel Gouke J
Department of Obstetrics and Gynecology .
J Psychosom Obstet Gynaecol. 2014 Dec;35(4):140-5. doi: 10.3109/0167482X.2014.952278. Epub 2014 Sep 10.
Psychopathology, psychosocial problems and substance use (PPS) commonly occur in pregnant women, and can have a negative impact on the course of pregnancy and the healthy development of the child. As PPS often remains undetected and untreated during pregnancy, we developed and implemented a four-step screen-and-treat protocol in routine obstetric care, with: (i) screening including triage and subsequent confirmation, (ii) indication assessment, (iii) transfer towards care and (iv) utilization of care. Adherence to the protocol and risk factors associated with dropout were examined for 236 Dutch pregnant women in a deprived urban area. Seventy-nine percent of women accepted the screening, 21% dropped out during triage, 15% during confirmation, 3% during transfer and 8% thereafter. Provided reasons for dropout were lack of time and lack of perceived benefit. In particular, smokers, multiparous women, and women of non-Western ethnicity dropout on the way towards mental and psychosocial care. For a successful implementation of the protocol in the future, with improved adherence of pregnant women to the protocol, education of women on PPS risks, motivational skills and compulsory treatment are worth investigation.
精神病理学、心理社会问题和物质使用（PPS）在孕妇中普遍存在，并且可能对妊娠过程和儿童的健康发育产生负面影响。由于PPS在孕期常常未被发现和治疗，我们在常规产科护理中制定并实施了一个四步筛查与治疗方案，包括：（i）筛查，包括分诊及随后的确诊；（ii）指征评估；（iii）转诊至护理机构；（iv）接受护理。我们对荷兰一个贫困城区的236名孕妇进行了研究，考察她们对该方案的依从性以及与退出相关的风险因素。79%的女性接受了筛查，21%在分诊时退出，15%在确诊时退出，3%在转诊时退出，8%在之后退出。报告的退出原因是时间不足和认为没有益处。特别是，吸烟者、经产妇和非西方族裔的女性在寻求心理和心理社会护理的过程中退出。为了未来成功实施该方案，提高孕妇对方案的依从性，对女性进行PPS风险教育、提高动机激发技巧以及强制治疗值得研究。
