设有和未设有产妇候产之家的医院中使用和未使用产妇候产之家的孕妇妊娠结局比较：回顾性队列研究
Comparison of pregnancy outcomes between maternity waiting home users and non-users at hospitals with and without a maternity waiting home: retrospective cohort study.
作者信息
Braat Floris, Vermeiden Tienke, Getnet Gashaw, Schiffer Rita, van den Akker Thomas, Stekelenburg Jelle
机构信息
Butajira General Hospital, Butajira, Southern Nations, Nationalities, and Peoples' Region, Ethiopia.
Department of Health Sciences, Global Health, University Medical Centre/University of Groningen, Groningen, The Netherlands.
出版信息
Int Health. 2018 Jan 1;10(1):47-53. doi: 10.1093/inthealth/ihx056.
OBJECTIVE
To examine the impact of a maternity waiting home (MWH) by comparing pregnancy outcomes between users and non-users at hospitals with and without an MWH.
METHODS
We conducted a retrospective cohort study in Ethiopia comparing one hospital with an MWH (Attat) to a second hospital without one (Butajira). A structured questionnaire among sampled women in 2014 and hospital records from 2011 to 2014 were used to compare sociodemographic characteristics and pregnancy outcomes between Attat MWH users and non-MWH users, Attat MWH users and Butajira, and Attat non-MWH users and Butajira. χ2 or ORs with 95% CIs were calculated.
RESULTS
Compared with Attat non-MWH users (n=306) and Butajira women (n=153), Attat MWH users (n=244) were more often multiparous (multipara vs primigravida: OR 4.43 [95% CI 2.94 to 6.68] and OR 3.58 [95% CI 2.24 to 5.73]), less educated (no schooling vs secondary school: OR 2.62 [95% CI 1.53 to 4.46] and OR 5.21 [95% CI 2.83 to 9.61], primary vs secondary school: OR 4.84 [95% CI 2.84 to 8.25] and OR 5.19 [95% CI 2.91 to 9.27]), poor (poor vs wealthy: OR 8.94 [95% CI 5.13 to 15.61] and OR 12.34 [95% CI 6.78 to 22.44] and further from the hospital (2 h 27 min vs 1 h 00 min and 1 h 12 min: OR 3.08 [95% CI 2.50 to 3.80] and OR 2.18 [95% CI 1.78 to 2.67]). Comparing hospital records of Attat MWH users (n=2784) with Attat non-users (n=5423) and Butajira women (n=9472), maternal deaths were 0 vs 20 (0.4%; p=0.001) and 31 (0.3%; p=0.003), stillbirths 38 (1.4%) vs 393 (7.2%) (OR 0.18 [95% CI 0.13 to 0.25]) and 717 (7.6%) (OR 0.17 [95% CI 0.12 to 0.24]) and uterine ruptures 2 (0.1%) vs 40 (1.1%) (OR 0.05 [95% CI 0.01 to 0.19]) and 122 (1.8%) (OR 0.04 (95% CI 0.01 to 0.16]). No significant differences were found regarding maternal deaths and stillbirths between Attat non-users and Butajira women.
CONCLUSIONS
Attat MWH users had less favourable sociodemographic characteristics but better birth outcomes than Attat non-users and Butajira women.
目的
通过比较设有和未设有产妇候产之家（MWH）的医院中使用者和非使用者的妊娠结局，研究产妇候产之家的影响。
方法
我们在埃塞俄比亚进行了一项回顾性队列研究，将一家设有产妇候产之家的医院（阿塔特）与另一家未设产妇候产之家的医院（布塔吉拉）进行比较。使用2014年对抽样妇女进行的结构化问卷调查以及2011年至2014年的医院记录，比较阿塔特产妇候产之家使用者与非使用者、阿塔特产妇候产之家使用者与布塔吉拉妇女、以及阿塔特非产妇候产之家使用者与布塔吉拉妇女之间的社会人口学特征和妊娠结局。计算χ2或95%置信区间的比值比（OR）。
结果
与阿塔特非产妇候产之家使用者（n = 306）和布塔吉拉妇女（n = 153）相比，阿塔特产妇候产之家使用者（n = 244）多为经产妇（经产妇与初产妇相比：OR 4.43 [95% CI 2.94至6.68]和OR 3.58 [95% CI 2.24至5.73]），受教育程度较低（未上学与中学相比：OR 2.62 [95% CI 1.53至4.46]和OR 5.21 [95% CI 2.83至9.61]，小学与中学相比：OR 4.84 [95% CI 2.84至8.25]和OR 5.19 [95% CI 2.91至9.27]），贫困（贫困与富裕相比：OR 8.94 [95% CI 5.13至15.61]和OR 12.34 [95% CI 6.78至22.44]），且距离医院更远（2小时27分钟与1小时00分钟和1小时12分钟相比：OR 3.08 [95% CI 2.50至3.80]和OR 2.18 [95% CI 1.78至2.67]）。比较阿塔特产妇候产之家使用者（n = 2784）与阿塔特非使用者（n = 5423）以及布塔吉拉妇女（n = 9472）的医院记录，孕产妇死亡人数分别为0例与20例（0.4%；p = 0.001）和31例（0.3%；p = 0.003），死产分别为38例（1.4%）与393例（7.2%）（OR 0.18 [95% CI 0.13至0.25]）和717例（7.6%）（OR 0.17 [95% CI 0.12至0.24]），子宫破裂分别为2例（0.1%）与40例（1.1%）（OR 0.05 [95% CI 0.01至0.19]）和122例（1.8%）（OR 0.04 [95% CI 0.01至0.16]）。阿塔特非使用者与布塔吉拉妇女之间在孕产妇死亡和死产方面未发现显著差异。
结论
阿塔特产妇候产之家使用者的社会人口学特征较差，但与阿塔特非使用者和布塔吉拉妇女相比，分娩结局更好。
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