Mortensen Berit, Lieng Marit, Diep Lien My, Lukasse Mirjam, Atieh Kefaya, Fosse Erik
The Intervention Centre, Oslo University Hospital, Rikshospitalet, The Intervention Centre, Sognsvannsveien 20, 0372 Oslo, Norway.
Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
EClinicalMedicine. 2019 Apr 16;10:84-91. doi: 10.1016/j.eclinm.2019.04.003. eCollection 2019 Apr.
From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occupied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation between the midwife-led model and maternal and neonatal health outcomes.
A register-based, retrospective cohort design was used, involving 2201 singleton births between January 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton pregnancies and mixed risk status, who either lived in villages that offered the midwife-led continuity model and had registered at the governmental clinic, or who lived in villages without the midwife-led model and received regular care, were compared. Primary outcome was unplanned caesarean section. Secondary outcomes were other modes of birth, postpartum anaemia, preterm birth, birth weight, and admission to neonatal intensive care unit.
Statistically significant less women receiving the midwife-led model had unplanned caesarean sections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64-0·99) and postpartum anaemia,19·8% vs 28·6%, aRR 0·72 (0·60-0·85). There was also a statistically significant lower rate of preterm births within the exposed group, 13·1% vs 16·8, aRR 0·79 (0·63-0·98), admission to neonatal intensive care unit, 7·0% vs 9·9%, aRR 0·71 (0·52-0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13 (0·02-0·97).
Receiving the midwife-led continuity model of care in Palestine was associated with several improved maternal and neonatal health outcomes. The findings support further implementation of the model. Implementation research, including randomised studies, would be useful to further investigate the effect and feasibility of the model in a low resource setting.
This study was partly funded by the Research Council of Norway through the Global Health and Vaccination Program (GLOBVAC), project number 243706. The implementation received public funding through Norwegian Aid Committee (NORWAC).
自2013年起，在被占领的巴勒斯坦纳布卢斯地区实施了由助产士主导的连续性护理模式，涉及一家政府医院和十个乡村。本研究分析了由助产士主导的模式与孕产妇和新生儿健康结局之间的关系。
采用基于登记的回顾性队列设计，纳入2016年1月至2017年6月在纳布卢斯政府医院出生的2201例单胎分娩。对农村单胎妊娠且风险状况各异的妇女的数据进行比较，这些妇女要么居住在提供助产士主导连续性模式并已在政府诊所登记的村庄，要么居住在没有助产士主导模式但接受常规护理的村庄。主要结局是计划外剖宫产。次要结局包括其他分娩方式、产后贫血、早产、出生体重以及新生儿重症监护病房收治情况。
接受助产士主导模式的妇女中计划外剖宫产的发生率在统计学上显著更低，分别为12.8%和15.9%，调整风险比（aRR）为0.80（95%置信区间0.64 - 0.99）；产后贫血发生率分别为19.8%和28.6%，aRR为0.72（0.60 - 0.85）。暴露组的早产率在统计学上也显著更低，分别为13.1%和16.8%，aRR为0.79（0.63 - 0.98）；新生儿重症监护病房收治率分别为7.0%和9.9%，aRR为0.71（0.52 - 0.98）；出生体重小于1500g的新生儿比例分别为0.1%和1.1%，aRR为0.13（0.02 - 0.97）。
在巴勒斯坦接受助产士主导的连续性护理模式与多项改善的孕产妇和新生儿健康结局相关。这些发现支持该模式的进一步实施。包括随机研究在内的实施研究，将有助于在资源匮乏环境中进一步调查该模式的效果和可行性。
本研究部分由挪威研究理事会通过全球卫生与疫苗接种计划（GLOBVAC）资助，项目编号243706。该模式的实施获得了挪威援助委员会（NORWAC）的公共资金。
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