Leicester City Football Club (LCFC) Research Programme, Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
BMC Pregnancy Childbirth. 2023 Jul 18;23(1):526. doi: 10.1186/s12884-023-05845-6.
Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents' preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians' opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
英格兰和威尔士近 30%的活产为晚期早产或早期足月（LPET），这与整个生命周期内健康不良结局的风险增加有关。然而，对于计划中的 LPET 分娩的决策过程或父母在这些过程中的参与情况，我们知之甚少。本文的目的是回顾关于一般产科决策中父母参与的证据，考虑可以推断出关于 LPET 分娩决策的内容，并提出进一步研究的方向。
使用 Medline、MIDIRS、PsycInfo 和 CINAHL 数据库进行了全面的叙述性文献综述。使用布尔运算符组合了适当的搜索词，以确保包括以下广泛领域：产科决策、父母参与、晚期早产和早期足月分娩以及分娩方式。
这篇综述表明，父母对自己参与决策的偏好各不相同。大多数母亲希望与临床医生共同决策，有一半的母亲对参与度不满意。临床医生对父母参与的限制的看法，特别是在母亲或婴儿的安全受到潜在威胁的情况下，对产科决策过程有很大的影响。其他重要因素包括背景因素（如讨论问题的性质以及是否存在相关医疗干预的指征）、人口统计学和其他个体特征（如种族和产次）、沟通质量；以及向父母提供的信息。
这篇综述强调了需要探索如何做出关于潜在 LPET 分娩的决策，以最大限度地提高母亲和父亲对参与决策过程的满意度，同时使临床医生既能最大限度地减少 LPET 分娩的数量，又能优化妇女和婴儿的健康。
