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南方三级保健中心产后输卵管结扎未满足的需求。

Unfulfilled Requests for Postpartum Tubal Ligation at a Southern Tertiary Care Center.

机构信息

Department of Obstetrics and Gynecology, Kaiser San Bernadino County, Fontana, California.

Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.

出版信息

N C Med J. 2022 Nov-Dec;83(6):448-453. doi: 10.18043/ncm.83.6.448.

Abstract

Nationally, multiple barriers lead only 50% of women who request postpartum tubal ligation to receive it prior to discharge. We aimed to identify characteristics associated with unfulfilled requests for postpartum tubal ligation at a tertiary medical center in the South. We conducted a retrospective chart review of all women delivering a live infant with a documented desire for postpartum sterilization between September 1, 2018, and November 30, 2018. The primary outcome was receipt of postpartum sterilization prior to discharge. We used chi-square and Mann Whitney U tests for descriptive analyses. One thousand seventy-two women delivered a live infant at our institution during our sampling frame. One hundred twenty-four had a documented desire for postpartum sterilization (124/1072, 12%). Eighty-one women (81/124, 65%) received their postpartum sterilization and 43 women (43/124, 35%) did not. Women who delivered by cesarean were more likely to receive their postpartum sterilization (63/68; 93%) than if they delivered vaginally (18/56; 32%) ( < .001). Lack of valid Medicaid consent ( = .006) was associated with unfulfilled requests for postpartum sterilization following vaginal delivery while BMI > 40 ( = .158) approached significance. Our sample is small and from a single institution. Additionally, the specific reason for tubal ligation nonfulfillment was often not documented. In this Southern institution, women delivering vaginally, those without a valid Medicaid consent form, and women with BMI > 40 were less likely to receive desired postpartum sterilization. Multipronged process changes are needed to fulfill patients' sterilization requests.

摘要

在全国范围内,只有 50%的要求产后输卵管结扎的女性在出院前接受了该手术。我们旨在确定在南方一家三级医疗中心与未满足的产后输卵管结扎要求相关的特征。我们对 2018 年 9 月 1 日至 11 月 30 日期间在我们机构分娩活婴并记录有产后绝育愿望的所有女性进行了回顾性病历审查。主要结局是在出院前接受产后绝育。我们使用卡方检验和曼-惠特尼 U 检验进行描述性分析。在我们的抽样框架内,有 1072 名女性分娩了活婴。124 名女性记录了产后绝育的愿望(124/1072,12%)。81 名女性(81/124,65%)接受了产后绝育,43 名女性(43/124,35%)没有。行剖宫产的女性更有可能接受产后绝育(63/68;93%),而阴道分娩的女性则不太可能(18/56;32%)(<0.001)。在阴道分娩后,缺乏有效的医疗补助同意书(=0.006)与未满足的产后绝育要求相关,而 BMI>40(=0.158)则接近显著。我们的样本量较小,且仅来自一家机构。此外,输卵管结扎未完成的具体原因往往没有记录。在这家南方医院,行阴道分娩的女性、没有有效医疗补助同意书的女性和 BMI>40 的女性更不可能接受所需的产后绝育。需要采取多管齐下的流程改变来满足患者的绝育要求。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f780/9851670/9b133a325987/nihms-1858222-f0001.jpg

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