de Visser Suzan M, Kirchner Christian A, van der Velden Bianca G J, de Wit Alexander C, Dijkman Anneke, Huisjes Anjoke J M, Middeldorp Johanna M, Moonen-Delarue Desirée, van Dillen Jeroen, Vandenbussche Frank P H A, Hulscher Marlies E, Scheepers Hubertina C J, Woiski Mallory D, Hermens Rosella P M G
Department of Obstetrics and Gynecology, Radboud Institute for Health Science, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Obstetrics and Gynecology, Radboud Institute for Health Science, Radboud University Medical Centre, Nijmegen, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2018 May;224:146-152. doi: 10.1016/j.ejogrb.2018.03.032. Epub 2018 Mar 20.
Major obstetric hemorrhage (MOH) is the leading cause of severe maternal morbidity and mortality, and can have a significant impact on a woman's life. This study aims to gain insight into the patients reported experiences (PREs) and outcomes (PROs) after a major obstetric hemorrhage, and to investigate which patients are most at risk for negative experiences.
A Consumer Assessment of Healthcare Providers and Systems (CAHPS) based questionnaire was developed covering items on the PREs and PROs, and send to all patients with blood loss exceeding 2500 ml in six hospitals over the period of 2008-2012. A regression analysis was performed to find determinants for negative experiences.
In total 372 of the 570 questionnaires were returned. Women scored the overall care before, during and after the MOH with a mean of 7.67, 7.62 and 7.28, respectively. However, most PRE items individually were scored suboptimal, with items regarding information supply scoring the lowest. Our results on the PROs showed 81% of the women (362) sustaining extreme fatigue, whereas problems with concentration (53% of 373 women), memory (49% of 353), or reliving (49% of 356) and irritability (51% of 355) were also frequently endured. Negative long term effects were observed in 28% of the women (106 of 372). We found 'year of the MOH longer ago', 'a lower total blood loss' and 'a large location of birth' to be determinants for negative experiences.
Women frequently reported negative experiences and outcomes following a MOH. Information supply after an MOH concerning both physical and psychological complaints is essential for the improvement of care.
严重产科出血（MOH）是孕产妇严重发病和死亡的主要原因，对女性生活有重大影响。本研究旨在深入了解严重产科出血患者报告的经历（PREs）和结局（PROs），并调查哪些患者出现负面经历的风险最高。
基于医疗服务提供者和系统消费者评估（CAHPS）开发了一份问卷，涵盖PREs和PROs相关项目，并于2008 - 2012年期间发送给六家医院中所有失血超过2500毫升的患者。进行回归分析以找出负面经历的决定因素。
总共570份问卷中返回了372份。女性对MOH前、中、后的整体护理评分分别为7.67、7.62和7.28。然而，大多数PRE项目的单项得分都不理想，其中信息提供项目得分最低。我们关于PROs的结果显示，81%的女性（362人）持续极度疲劳，而注意力不集中（373名女性中的53%）、记忆力问题（353名中的49%）、反复回忆（356名中的49%）和易怒（355名中的51%）也很常见。28%的女性（372人中的106人）观察到长期负面影响。我们发现“MOH发生时间更早”、“总失血量较低”和“分娩地点较大”是负面经历的决定因素。
女性在严重产科出血后经常报告负面经历和结局。严重产科出血后关于身体和心理不适的信息提供对于改善护理至关重要。
