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美国妇产科医师学会第736号委员会意见摘要:优化产后护理。

ACOG Committee Opinion No. 736 Summary: Optimizing Postpartum Care.

出版信息

Obstet Gynecol. 2018 May;131(5):949-951. doi: 10.1097/AOG.0000000000002628.

Abstract

The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman's individual needs. It is recommended that all women have contact with their obstetrician-gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contracep-tion, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance. Women with chronic medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, renal disease, and mood disorders should be counseled regarding the importance of timely follow-up with their obstetrician-gynecologists or primary care providers for ongoing coordination of care. During the postpartum period, the woman and her obstetrician-gynecologist or other obstetric care provider should identify the health care provider who will assume primary responsibility for her ongoing care in her primary medical home. Optimizing care and support for postpartum families will require policy changes. Changes in the scope of postpartum care should be facilitated by reimbursement policies that support postpartum care as an ongoing process, rather than an isolated visit. Obstetrician-gynecologists and other obstetric care providers should be in the forefront of policy efforts to enable all women to recover from birth and nurture their infants. This Committee Opinion has been revised to reinforce the importance of the "fourth trimester" and to propose a new paradigm for postpartum care.

摘要

产后的几周对女性及其婴儿来说是关键时期,为长期健康和幸福奠定基础。为了优化女性和婴儿的健康,产后护理应成为一个持续的过程,而非单次接触,应根据每位女性的个体需求提供服务和支持。建议所有女性在产后3周内与她们的妇产科医生或其他产科护理提供者取得联系。这一初步评估之后应根据需要进行持续护理,在出生后不迟于12周进行一次全面的产后检查。全面的产后检查应包括对身体、社会和心理健康的全面评估,包括以下方面:情绪和情感健康;婴儿护理和喂养;性、避孕和生育间隔;睡眠和疲劳;产后身体恢复;慢性病管理;以及健康维护。患有高血压疾病、肥胖症、糖尿病、甲状腺疾病、肾脏疾病和情绪障碍等慢性疾病的女性,应就及时与妇产科医生或初级保健提供者随访以持续协调护理的重要性接受咨询。在产后期间,女性及其妇产科医生或其他产科护理提供者应确定在其主要医疗场所对其持续护理承担主要责任的医疗保健提供者。优化对产后家庭的护理和支持将需要政策变革。报销政策应促进产后护理范围的变化,这些政策应支持将产后护理作为一个持续的过程,而非一次孤立的就诊。妇产科医生和其他产科护理提供者应站在政策努力的前沿,以使所有女性能够从分娩中恢复并养育她们的婴儿。本委员会意见已修订,以强化“孕晚期后阶段”的重要性,并提出一种产后护理的新模式。

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