使用母婴安全温度计评估巴西东南部无伤害护理：一项基于医院的队列研究。

Using the Maternity Safety Thermometer to estimate harm-free care in Southeast Brazil: A hospital-based cohort.

机构信息

Department of Social Medicine, School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.

Health Board III (Medicine), University Nove de Julho, São Paulo, Brazil.

出版信息

Birth. 2019 Dec;46(4):583-591. doi: 10.1111/birt.12454. Epub 2019 Oct 3.

DOI:10.1111/birt.12454

PMID:31579979

Abstract

BACKGROUND

High rates of unnecessary cesareans and interventions in vaginal births contribute to stagnant maternal and neonatal mortality rates in Brazil. We used the Maternity Safety Thermometer (MST) to assess the prevalence of harm during maternity care.

METHODS

This secondary analysis of the "Birth in Brazil" survey included a representative sample of 10 155 women who gave birth in public and private hospitals in southeastern Brazil. The main outcomes were perineal and abdominal trauma, maternal infection and hemorrhage, newborn vitality, and women's perception of safety. We calculated the odds ratios (OR) for the number of MST harms (dependent variable).

RESULTS

About 81.6% of the women with vaginal births had sutures for perineal trauma (87.7% of these due to episiotomies). Poor perception of safety was reported by 83.1% of women, and 69.5% of all infants not admitted to the NICU were separated from their mother after birth. The overall rate of cesarean birth was 52.6%, and 7.5% of term infants were admitted to the NICU. In public settings, having an intrapartum cesarean significantly increased the chances of one (OR 2.21; 95% CI 1.20-4.07), or two or more (4.08 [2.27-7.32]) harms. In private settings, cesarean deliveries without labor were also associated with higher chances of one (4.26 [2.65-6.85]), or two or more (4.60 [2.35-9.02]) harms. Only 2% of the women had harm-free care.

CONCLUSIONS

In southeastern Brazil, there is a high prevalence of preventable harm during maternity care.

摘要

背景

巴西的产妇和新生儿死亡率停滞不前，这主要是由于剖宫产率和阴道分娩干预率过高。我们使用产妇安全温度计（Maternity Safety Thermometer，MST）来评估产时护理中伤害的发生率。

方法

本研究对“巴西分娩”调查进行了二次分析，共纳入了 10155 名在巴西东南部公立和私立医院分娩的代表性产妇。主要结局包括会阴和腹部创伤、产妇感染和出血、新生儿活力以及产妇对安全性的感知。我们计算了 MST 伤害数量的比值比（odds ratio，OR）（因变量）。

结果

约 81.6%的阴道分娩产妇有会阴创伤缝合（87.7%的会阴切开术）。83.1%的产妇对安全性的感知较差，69.5%的所有未入住新生儿重症监护病房（NICU）的新生儿在出生后与母亲分离。总体剖宫产率为 52.6%，7.5%的足月婴儿入住 NICU。在公共环境中，产时剖宫产显著增加了发生 1 种（OR 2.21；95%CI 1.20-4.07）或 2 种及以上（4.08 [2.27-7.32]）伤害的可能性。在私立环境中，无产程的剖宫产也与发生 1 种（4.26 [2.65-6.85]）或 2 种及以上（4.60 [2.35-9.02]）伤害的可能性增加有关。只有 2%的产妇接受了无伤害的护理。