Poškienė Ingrida, Vanagas Giedrius, Kirkilytė Asta, Nadišauskienė Rūta Jolanta
Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Medical Academy, Eiveniu st. 2, Kaunas, Lithuania.
Institute of Pharmacoeconomics, Kaunas, Lithuania.
Open Med (Wars). 2021 Oct 15;16(1):1537-1543. doi: 10.1515/med-2021-0373. eCollection 2021.
Experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth.
The aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes.
Pregnant women in Kaunas city maternity care facilities.
A propensity score-matched case-control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann-Whitney test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups.
After adjusting groups for propensity score, postpartum haemorrhage differences between physician-led and midwifery-led labours were significantly different (169.5 and 152.6 mL; = 0.026), same for hospital stay duration (3.3 and 3.1 days, = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi = 4.8; = 0.029), newborn Apgar 5 min score (9.58 and 9.76; = 0.002), and pain relief (chi = 14.9; = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure.
The midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and does not influence the rate of successful spontaneous vaginal births.
许多国家的专家建议扩大以助产士为主导的护理模式，以此作为改善孕产妇和新生儿结局、降低不必要干预率、实现成本节约并促进正常自然阴道分娩的一种模式。
本研究旨在比较以助产士为主导和以妇产科医生为主导的护理模式下的阴道分娩结局。
考纳斯市产科护理机构中的孕妇。
一项对以助产士为主导与以医生为主导的低风险分娩结局进行倾向评分匹配的病例对照研究。比较两组之间的患者特征和结局。连续变量以均值±标准差表示，并使用曼-惠特尼检验进行分析。分类变量和二元变量以频率（百分比）表示，差异使用卡方检验进行分析。对未匹配组（倾向评分匹配前[PSM]）和匹配组（PSM后）分别进行分析。
在对两组进行倾向评分调整后，以医生为主导和以助产士为主导的分娩产后出血差异显著（分别为169.5毫升和152.6毫升；P = 0.026），住院时间差异也显著（分别为3.3天和3.1天，P = 0.042）。此外，在匹配人群中，会阴切开术发生率（卡方值 = 4.8；P = 0.029）、新生儿出生后5分钟阿氏评分（分别为9.58和9.76；P = 0.002）以及疼痛缓解情况（卡方值 = 14.9；P = 0.002）存在显著差异。在未匹配人群中观察到分娩期间使用的产科操作、母乳喂养、引产、新生儿出生后1分钟阿氏评分以及作为总体自然阴道分娩成功衡量指标的成功阴道分娩方面存在显著差异，但在匹配人群中未得到证实。
以助产士为主导的护理模式在会阴切开术发生率、住院时间、产后出血以及新生儿出生后5分钟阿氏评分方面与以医生为主导的护理模式存在显著差异。以助产士为主导的护理与以医生为主导的护理一样安全，且不影响自然阴道分娩的成功率。
