Nyman Viola, Roshani Leyla, Berg Marie, Bondas Terese, Downe Soo, Dencker Anna
Department of Research and Development at NU-Hospital Group, Trollhattan, Sweden; Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden.
Department of Research and Development, NU-Hospital Group, Trollhättan, Sweden.
Sex Reprod Healthc. 2017 Mar;11:86-90. doi: 10.1016/j.srhc.2016.11.001. Epub 2016 Nov 10.
Unnecessary routine interventions in uncomplicated labour and birth, like cardiotocography (CTG), amniotomy, use of scalp electrode and oxytocin treatment, are associated with further interventions that could harm the woman and the infant. A four year Action Research (AR) project was done on a labour ward to enhance the capacity of local midwives in the promotion of physiological labour and birth.
To describe the use of interventions during labour and birth in healthy women at term with spontaneous onset of labour, before and after initiation of an Action Research project.
A retrospective before and after comparative study of clinical records from 2009 (before) and 2012 (after), based on a random selection of records from primiparous and multiparous women. Outcome measures were duration of admission CTG, frequency of admission CTG over 30min, frequency of amniotomy, use of scalp electrode, and frequency of oxytocin augmentation in spontaneous labour.
903 records were included. The duration of admission CTG (p=0.001), frequency of admission CTG duration over 30min (p=<0.001), the use of scalp electrodes (p=<0.001), and use of oxytocin augmentation of spontaneous labour (p=0.014) were reduced significantly after initiation of the AR project. There were no significant differences in frequency of amniotomy, duration of total CTG, postpartum bleeding, sphincter tears, Apgar score <5 at 5min, and mode of birth.
Following an AR project, several interventions were reduced during labour and birth. Controlled studies in other settings are needed to assess the impact of collaborative action on decreasing unnecessary interventions.
在无并发症的分娩过程中，诸如胎心监护（CTG）、人工破膜、使用头皮电极和催产素治疗等不必要的常规干预措施，会引发可能对产妇和婴儿造成伤害的进一步干预。在一个产房开展了一项为期四年的行动研究（AR）项目，以提高当地助产士促进自然分娩的能力。
描述在一项行动研究项目启动前后，足月自然发动分娩的健康产妇在分娩过程中干预措施的使用情况。
对2009年（之前）和2012年（之后）的临床记录进行回顾性前后对比研究，记录从初产妇和经产妇中随机选取。观察指标包括入院CTG监护时长、监护时长超过30分钟的入院CTG频率、人工破膜频率、头皮电极的使用情况以及自然分娩中催产素加强宫缩的频率。
共纳入903份记录。行动研究项目启动后，入院CTG监护时长（p = 0.001）、监护时长超过30分钟的入院CTG频率（p < 0.001）、头皮电极的使用（p < 0.001）以及自然分娩中催产素加强宫缩的使用（p = 0.014）均显著减少。人工破膜频率、总CTG监护时长、产后出血、括约肌撕裂、5分钟时阿氏评分<5以及分娩方式方面无显著差异。
在行动研究项目之后，分娩过程中的多项干预措施有所减少。需要在其他环境中进行对照研究，以评估合作行动对减少不必要干预的影响。
