Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology; Department of Family Medicine; and Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.).
Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., E.L.H., C.D.).
Ann Intern Med. 2024 Jan;177(1):50-64. doi: 10.7326/M23-2676. Epub 2024 Jan 2.
Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests that disrespectful care during childbirth contributes to this problem.
To conduct a systematic review on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving maternal and infant health outcomes for those who are pregnant and postpartum, and strategies for implementation.
Systematic searches of Ovid Medline, CINAHL, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and SocINDEX for English-language studies (inception to July 2023).
Randomized controlled trials and nonrandomized studies of interventions of RMC versus usual care for effectiveness studies; additional qualitative and noncomparative validation studies for definitions and measurement studies.
Dual data abstraction and quality assessment using established methods, with resolution of disagreements through consensus.
Thirty-seven studies were included across all questions, of which 1 provided insufficient evidence on the effectiveness of RMC to improve maternal outcomes and none studied RMC to improve infant outcomes. To define RMC, authors identified 12 RMC frameworks, from which 2 main concepts were identified: and frameworks. Disrespect and abuse components focused on recognizing birth mistreatment; rights-based frameworks incorporated aspects of reproductive justice, human rights, and antiracism. Five overlapping framework themes include freedom from abuse, consent, privacy, dignity, communication, safety, and justice. Twelve tools to measure RMC were validated in 24 studies on content validity, construct validity, and internal consistency, but lack of a gold standard limited evaluation of criterion validity. Three tools specific for RMC had at least 1 study demonstrating consistency internally and with an intended construct relevant to U.S. settings, but no single tool stands out as the best measure of RMC.
No studies evaluated other health outcomes or RMC implementation strategies. The lack of definition and gold standard limit evaluation of RMC tools.
Frameworks for RMC are well described but vary in their definitions. Tools to measure RMC demonstrate consistency but lack a gold standard, requiring further evaluation before implementation in U.S. settings. Evidence is lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome.
Agency for Healthcare Research and Quality. (PROSPERO: CRD42023394769).
美国的严重孕产妇发病率和死亡率比所有类似国家都要糟糕，而黑人妇女受到的影响最大。新出现的研究表明，分娩过程中不尊重的护理是造成这一问题的原因。
对尊重产妇护理（RMC）的定义和有效测量方法进行系统评价，评估其对改善孕产妇和产后健康结果的有效性，并确定实施策略。
系统检索 Ovid Medline、CINAHL、Embase、Cochrane 对照试验中心注册库、PsycInfo 和 SocINDEX 中的英文文献（从创建到 2023 年 7 月）。
RMC 与常规护理的干预措施的随机对照试验和非随机研究，用于有效性研究；定义和测量研究的其他定性和非比较验证研究。
使用既定方法进行双重数据提取和质量评估，并通过共识解决分歧。
所有问题共纳入 37 项研究，其中 1 项研究提供的关于 RMC 改善产妇结局的有效性证据不足，没有研究表明 RMC 可以改善婴儿结局。为了定义 RMC，作者确定了 12 个 RMC 框架，从中确定了 2 个主要概念：互动和关系框架。不尊重和虐待成分侧重于识别分娩虐待；基于权利的框架纳入了生殖正义、人权和反种族主义的方面。五个重叠的框架主题包括免受虐待、同意、隐私、尊严、沟通、安全和正义。12 种衡量 RMC 的工具在 24 项研究中验证了内容有效性、结构有效性和内部一致性，但缺乏金标准限制了对效标效度的评估。3 种特定于 RMC 的工具至少有 1 项研究在内部具有一致性，并与与美国相关的预期结构相关，但没有一种工具脱颖而出成为衡量 RMC 的最佳工具。
没有研究评估其他健康结果或 RMC 实施策略。缺乏 RMC 工具的定义和金标准限制了评估。
RMC 的框架描述得很好，但在定义上有所不同。衡量 RMC 的工具具有一致性，但缺乏金标准，在美国环境中实施之前需要进一步评估。没有证据表明实施 RMC 可以改善任何孕产妇或婴儿的健康结果。
美国医疗保健研究与质量局。（PROSPERO：CRD42023394769）。
