Michigan Department of Health and Human Services, Lansing, Michigan.
J Midwifery Womens Health. 2019 Jul;64(4):421-426. doi: 10.1111/jmwh.12958. Epub 2019 Mar 14.
In Michigan, pulse oximetry screening rates for critical congenital heart defects (CCHDs) are assessed for birthing hospitals but have not been assessed for the midwife-attended births that occur in the out-of-hospital birth community. This analysis was conducted to determine pulse oximetry screening rates among the midwife-attended out-of-hospital birth community in Michigan overall, and among midwives provided with loaned pulse oximeters from the Michigan Department of Health and Human Services (MDHHS).
Records for midwife-attended out-of-hospital births between April 1, 2014, and December 31, 2016, were linked via probabilistic matching with newborn screening records. Pulse oximetry screening rates were calculated for the midwife-attended out-of-hospital birth population overall, by midwife, and stratified by receipt of loaned pulse oximeters from MDHHS. Births from midwives who attended 5 or more nonhospital births during the study period were included in this analysis.
Of the 3410 midwife-attended out-of-hospital births, 20.8% (n = 710) reported as having received a pulse oximetry screening for CCHDs. For births attended by midwives who received pulse oximeters from MDHHS, 50.5% had pulse oximetry screening results reported, compared with 12.7% among births attended by midwives without a loaned pulse oximeter. Of the 78 total midwives, 18% (n = 14) reported pulse oximetry screening results on more than half of the births they attended. Of the 14 midwives who received a pulse oximeter from MDHHS, 50.0% (n = 7) reported screening results for more than half of all births they attended.
Our findings indicate that CCHD screening rates are low among midwife-attended out-of-hospital birth community. Screening rates were higher among midwives who received a pulse oximeter from MDHHS, but fewer than half of the attended births had a reported pulse oximetry screening. Further discussions with the midwife-attended out-of-hospital birth community to better understand screening barriers may be beneficial.
在密歇根州，对参与分娩的医院进行了关键型先天性心脏缺陷（CCHD）的脉搏血氧饱和度筛查率评估，但并未对在院外分娩社区中由助产士参与的分娩进行评估。本分析旨在确定密歇根州整体由助产士参与的院外分娩社区的脉搏血氧饱和度筛查率，以及接受密歇根州卫生与公众服务部（MDHHS）出借脉搏血氧计的助产士的筛查率。
通过概率匹配将 2014 年 4 月 1 日至 2016 年 12 月 31 日期间由助产士参与的院外分娩记录与新生儿筛查记录相关联。根据接受 MDHHS 出借的脉搏血氧计的情况，计算了由助产士参与的院外分娩人群的脉搏血氧饱和度筛查率，同时按助产士进行分层。在研究期间，有 5 次或以上非医院分娩经历的助产士的分娩包含在本分析中。
在 3410 例由助产士参与的院外分娩中，20.8%（n=710）报告称进行了 CCHD 的脉搏血氧饱和度筛查。在接受 MDHHS 脉搏血氧计的助产士所参与的分娩中，有 50.5%的分娩报告了脉搏血氧饱和度筛查结果，而在未接受出借脉搏血氧计的助产士所参与的分娩中，这一比例为 12.7%。在总共 78 名助产士中，18%（n=14）报告说，她们在一半以上的分娩中进行了脉搏血氧饱和度筛查。在从 MDHHS 获得脉搏血氧计的 14 名助产士中，有 50.0%（n=7）报告说，在她们所参与的一半以上分娩中进行了筛查。
我们的发现表明，由助产士参与的院外分娩社区的 CCHD 筛查率较低。在接受 MDHHS 脉搏血氧计的助产士中，筛查率较高，但只有不到一半的分娩报告了脉搏血氧饱和度筛查。与由助产士参与的院外分娩社区进行进一步的讨论，以更好地了解筛查障碍，可能会有所帮助。
