张的指南与世界卫生组织产程图对分娩体验的影响：以分娩进展研究（LaPS）中的分娩体验问卷为衡量标准：一项整群随机试验。
The effect of Zhang's guideline vs the WHO partograph on childbirth experience measured by the Childbirth Experience Questionnaire in the Labor Progression Study (LaPS): A cluster randomized trial.
机构信息
Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
Faculty of Health Sciences, Department of Caring and Ethics, University of Stavanger, Stavanger, Norway.
出版信息
Acta Obstet Gynecol Scand. 2022 Feb;101(2):193-199. doi: 10.1111/aogs.14298. Epub 2021 Dec 2.
INTRODUCTION
Childbirth experience is an increasingly recognized and important measure of quality of obstetric care. Previous research has shown that it can be affected by intrapartum care and how labor is followed. A partograph is recommended to follow labor progression by recording cervical dilation over time. There are currently different guidelines in use worldwide to follow labor progression. The two main ones are the partograph recommended by the World Health Organization (WHO) based on the work of Friedman and Philpott and a guideline based on Zhang's research. In our study we assessed the effect of adhering to Zhang's guideline or the WHO partograph on childbirth experience. Zhang's guideline describes expected normal labor progression based on data from contemporary obstetric populations, resulting in an exponential progression curve, compared with the linear WHO partograph. The choice of labor curve affects the intrapartum follow-up of women and this could potentially affect childbirth experience.
MATERIAL AND METHODS
The Labor Progression Study (LaPS) study was a prospective, cluster randomized controlled trial conducted at 14 birth centers in Norway. Birth centers were randomized to either follow Zhang's guideline or the WHO partograph. Nulliparous women in active labor, with one fetus in cephalic presentation at term and spontaneous labor onset were included. At 4 weeks postpartum, included women received an online login to complete the Childbirth Experience Questionnaire (CEQ). Total score on the CEQ, the four domain scores on the CEQ, and scores on the individual items on the CEQ were compared between the two groups.
RESULTS
There were 1855 women in the Zhang group and 1749 women in the WHO partograph group. There was no difference in the total or domain CEQ scores between the two groups. We found statistically significant differences for two individual items; women in the Zhang group scored lower on positive memories and feeling of control.
CONCLUSIONS
Based on our findings on childbirth experience there is no reason to prefer Zhang's guideline over the WHO partograph.
引言
分娩体验是评估产科护理质量的一个日益受到重视的指标。既往研究表明，分娩体验可受到产程中护理以及产程监测方式的影响。产程图用于记录宫颈扩张程度随时间的变化，以监测产程进展。目前，全世界范围内使用的产程图监测指南各不相同，主要有基于 Friedman 和 Philpott 研究结果制定的世界卫生组织（WHO）产程图推荐指南，以及基于 Zhang 研究结果制定的指南。本研究旨在评估遵循 Zhang 指南或 WHO 产程图对分娩体验的影响。Zhang 指南描述了基于当代产科人群数据的正常分娩进展，表现为指数型进展曲线，而 WHO 产程图则为线性。产程曲线的选择会影响对产妇的产程监测，从而可能影响分娩体验。
材料与方法
LaPS 研究是一项在挪威 14 家分娩中心开展的前瞻性、整群随机对照试验。分娩中心被随机分为两组，分别遵循 Zhang 指南或 WHO 产程图。纳入标准为：初产妇、单胎头位、足月、自发临产。产后 4 周时，纳入产妇会收到一个在线登录链接，以完成分娩体验问卷（CEQ）。比较两组产妇的 CEQ 总分、CEQ 四个维度评分和 CEQ 各条目评分。
结果
Zhang 组纳入 1855 例产妇，WHO 产程图组纳入 1749 例产妇。两组的 CEQ 总分和各维度评分均无统计学差异。在两个单独的条目上存在统计学差异，即 Zhang 组的产妇对分娩的积极记忆和控制感评分较低。
结论
基于我们对分娩体验的研究结果，没有理由偏好 Zhang 指南而非 WHO 产程图。
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