University of Minnesota Rural Health Research Center, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
J Rural Health. 2021 Mar;37(2):385-393. doi: 10.1111/jrh.12539. Epub 2020 Nov 17.
Rural hospitals are closing obstetric units, and limited information is available about local emergency obstetric preparedness and capacity in rural communities where hospitals do not routinely provide this care.
To describe emergency obstetric capacity at rural US hospitals that do not routinely offer childbirth services.
Data from the 2018 American Hospital Association Annual Survey were used to identify a random sample of rural hospitals that did not offer obstetric services. A survey was developed based on World Health Organization criteria for obstetric emergencies. With data collected from 69 rural hospital emergency departments (48% response rate), we analyzed local capacity to support childbirth.
Most responding hospitals (65%) were located 30 or more miles away from a hospital with obstetric services. Some reported having emergency room births in the past year (28%), an unanticipated adverse birth outcome (32%), and/or a delay in urgent transport for a pregnant patient (22%). More than 90% of responding hospitals had capacity for blood transfusion, intravenous antibiotics or anticonvulsants, and basic neonatal resuscitation. However, less than one-fifth had capacity to perform surgery (16%), remove retained products of delivery (17%), or had a policy for emergency cesarean (18%). Almost all respondents (80%) reported the need for additional training or resources to handle emergency obstetric situations.
Many rural hospitals do not have basic capacity to provide emergency obstetric services. Programs and policies to improve this may focus on surgical care, clinician and staff training, transportation, and coordination with nearby hospitals that provide obstetric services.
农村医院正在关闭产科病房，而关于农村社区的紧急产科准备情况和能力的信息有限，在这些社区，医院通常不提供此类护理。
描述不常规提供分娩服务的美国农村医院的紧急产科能力。
使用 2018 年美国医院协会年度调查的数据，确定了一个不提供产科服务的农村医院的随机样本。根据世界卫生组织产科急症标准制定了一项调查。通过对 69 家农村医院急诊科的数据（48%的回复率）进行分析，我们研究了支持分娩的当地能力。
大多数（65%）回复的医院距离有产科服务的医院有 30 英里或以上。一些医院报告在过去一年中进行了急诊室分娩（28%）、意外不良分娩结局（32%）和/或紧急转运孕妇时出现延误（22%）。超过 90%的回复医院具备输血、静脉内抗生素或抗惊厥药以及基本新生儿复苏的能力。然而，不到五分之一的医院（16%）具备手术能力、取出残留的胎盘组织（17%）或有紧急剖宫产的政策（18%）。几乎所有（80%）的受访者都报告需要额外的培训或资源来处理紧急产科情况。
许多农村医院没有提供紧急产科服务的基本能力。可能需要针对手术护理、临床医生和工作人员培训、交通以及与提供产科服务的附近医院的协调等方面来制定相关项目和政策。
