采用系统方法降低初产妇剖宫产率

Implementing a Systematic Approach to Reduce Cesarean Birth Rates in Nulliparous Women.

作者信息

Bell Amy D, Joy Saju, Gullo Susan, Higgins Robert, Stevenson Eleanor

机构信息

Carolinas HealthCare System, Charlotte, North Carolina; the Institute for Healthcare Improvement, Cambridge, Massachusetts; and Duke University School of Nursing, Durham, North Carolina.

出版信息

Obstet Gynecol. 2017 Nov;130(5):1082-1089. doi: 10.1097/AOG.0000000000002263.

DOI:10.1097/AOG.0000000000002263

PMID:29016505

Abstract

OBJECTIVE

To implement a systematic approach to safely reduce nulliparous cesarean birth rates.

METHODS

This is a quality improvement project at two rural community hospitals and one urban community hospital in North Carolina. These facilities implemented a systematic approach to reduce nulliparous cesarean birth rates, aligning with recommendations developed by the Council on Patient Safety in Women's Health Care: Patient Safety Bundle on the Safe Reduction of Primary Cesarean Births. Health care providers and nurses received education on contemporary labor management guidelines developed by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine Obstetric Care Consensus regarding safe prevention of primary cesarean deliveries and nurses were instructed on labor support techniques. The preguideline implementation period was January 1, 2015, to June 30, 2015. The postguideline implementation period was July 1, 2016, to December 31, 2016. The primary outcome measured was the nulliparous, term, singleton, vertex cesarean birth rate. Secondary outcomes included maternal and neonatal outcomes. Standard statistical analysis was used and a P value of <.05 was considered significant.

RESULTS

There were 434 women identified in the preguideline period and 401 women in the postguideline period. The nulliparous, term, singleton, vertex cesarean birth rate decreased from 27.9% to 19.7% [odds ratio (OR) 0.63, CI 0.46-0.88]. There were improvements in health care provider compliance with following the labor management guidelines from 86.2% to 91.5% (OR 1.73, 95% CI 1.11-2.70), the use of maternal position changes from 78.7% to 87.5% (OR 1.86, 95% CI 1.29-2.68), and use of the peanut birthing ball from 16.8% to 45.2% (OR 3.83, 95% CI 2.84-5.16) as provisions for labor support.

DISCUSSION

Implementing a systematic approach for care of nulliparous women is associated with a decrease in term, singleton, vertex cesarean birth rates.

摘要

目的

实施一种系统方法以安全降低初产妇剖宫产率。

方法

这是一项在北卡罗来纳州的两家农村社区医院和一家城市社区医院开展的质量改进项目。这些机构实施了一种系统方法来降低初产妇剖宫产率，与妇女保健患者安全委员会制定的《安全降低初次剖宫产率患者安全套餐》中的建议保持一致。医护人员接受了关于美国妇产科医师学会和母胎医学协会产科护理共识制定的当代分娩管理指南的培训，内容涉及安全预防初次剖宫产，护士也接受了分娩支持技术的指导。指南实施前阶段为2015年1月1日至2015年6月30日。指南实施后阶段为2016年7月1日至2016年12月31日。所测量的主要结局是初产妇、足月、单胎、头位剖宫产率。次要结局包括孕产妇和新生儿结局。采用标准统计分析，P值<0.05被认为具有统计学意义。

结果

指南实施前阶段确定了434名女性，指南实施后阶段有401名女性。初产妇、足月、单胎、头位剖宫产率从27.9%降至19.7%[优势比（OR）0.63，可信区间（CI）0.46 - 0.88]。医护人员遵循分娩管理指南的依从性从86.2%提高到91.5%（OR 1.73，95%CI 1.11 - 2.70），产妇体位改变的使用率从78.7%提高到87.5%（OR 1.86，95%CI 1.29 - 2.68），以及花生分娩球作为分娩支持措施的使用率从16.8%提高到45.2%（OR 3.83，95%CI 2.84 - 5.16）。