荷兰北部寻求庇护者的妊娠结局：回顾性文献分析。
Pregnancy outcomes in asylum seekers in the North of the Netherlands: a retrospective documentary analysis.
机构信息
Department of Obstetrics and Gynaecology and Department of Health Sciences, Global Health, University Medical Center Groningen/University of Groningen, Hanzeplein, 19713 GZ, Groningen, the Netherlands.
Refaja ziekenhuis Stadskanaal, Boerhaavestraat, 19501 HE, Stadskanaal, the Netherlands.
出版信息
BMC Pregnancy Childbirth. 2020 May 25;20(1):320. doi: 10.1186/s12884-020-02985-x.
BACKGROUND
With more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care.
METHODS
Using a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors.
RESULTS
A total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p = 0.000), labour was less often induced (36.9 vs. 43.8, p = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy.
CONCLUSION
Pregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.
背景
随着每年超过 20000 名寻求庇护者的到来，为这一人群提供医疗保健已成为一个重要问题。寻求庇护的孕妇似乎面临不良妊娠结局的风险。本研究旨在评估寻求庇护者与当地荷兰人口的妊娠结局差异，并确定潜在的护理标准不足因素。
方法
使用回顾性研究设计，我们比较了 2012 年 1 月至 2016 年 12 月在荷兰北部地区分娩的寻求庇护和荷兰妇女的妊娠结局。比较了以下数据：围产期死亡率、孕产妇死亡率、分娩时的胎龄、早产、出生体重、小于胎龄儿、阿普加评分、宫内胎儿死亡、分娩方式和疼痛药物需求。对寻求庇护者的围产期死亡病例进行了潜在标准不足因素的审查。
结果
共纳入 344 名寻求庇护的妇女和 2323 名荷兰妇女。寻求庇护者的围产期死亡率较高（3.2%比 0.6%，p=0.000），包括宫内胎儿死亡的发生率较高（2.3%比 0.2%，p=0.000），胎龄较大（39+4 周比 38+6 周，p=0.000），分娩时较少使用催产素（36.9%比 43.8%，p=0.016），产后住院时间更长（2.24 天比 1.72 天，p=0.006），阿片类镇痛药的使用率更高（27.3%比 22%，p=0.029）。寻求庇护者所生婴儿的出生体重较低（3265 克比 3385 克，p=0.000），且较小的胎龄儿比例较高（13.9%比 8.4%，p=0.002）。多变量分析显示，寻求庇护妇女围产期死亡率增加的风险独立于产次、出生体重和胎龄。对寻求庇护者的围产期死亡病例进行审查后发现，可能存在标准不足的因素，如产前保健开始较晚、因交通问题错过预约、未识别警报症状、不知道联系谁以及在妊娠期间转移到其他地点。
结论
孕妇面临不良妊娠结局的风险增加。需要进一步研究以确定哪些特定的风险因素与寻求庇护者不良围产期结局有关，并确定改善这一弱势群体孕妇围产期护理的策略。
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