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评估产妇保健服务可及性:对剖宫产术和难产的影响。

Assessing maternity care access: impacts on cesarean sections and dystocia.

机构信息

Gachon Biomedical and Convergence Institute, Gachon University Gil Medical Center, Incheon, South Korea.

Department of Ophthalmology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea.

出版信息

BMC Pregnancy Childbirth. 2024 Aug 22;24(1):550. doi: 10.1186/s12884-024-06746-y.

Abstract

BACKGROUND

As South Korea grapples with a declining birthrate, maternity care accessibility has become challenging. This study examines the association with labour intervention and pregnancy complication, specifically focusing on C-section and dystocia in maternity disparities.

METHODS

Data from the South Korean NHIS-NID was used to analyze 1,437,186 women with childbirths between 2010 and 2015. The research defines 50 specific districts as Obstetrically Underserved Areas produced by the Ministry of Health and Welfare in 2011. C-Section were assessed through using medical procedure and DRG codes, while dystocia was defined using ICD-10 code. Logistic regression analysis was used to examine the significance of the association.

RESULTS

Among the population residing in underserved areas, 42,873 out of a total of 1,437,186 individuals were identified. For nationwide cases, the odds ratios (ORs) for C-Section were 1.11 (95% CI: 1.08-1.13) and dystocia were 1.07 (95% CI: 1.05-1.09). In relatively accessible urban areas, the ORs for C-Section and dystocia, based on whether they were obstetrically underserved areas, were 1.16 (95% CI: 1.13-1.18) and 1.10 (95% CI: 1.08-1.19), respectively.

CONCLUSION

Poor accessibility to maternity care facilities is closely linked to high-risk pregnancies, including an increased incidence of dystocia and a higher rate of C-sections. Insufficient access to maternity care not only raises the risk of serious pregnancy complications. Consequently, there is a pressing need for multi-faceted efforts to bridge this disparity.

摘要

背景

随着韩国出生率的下降,产妇保健的可及性已成为一个挑战。本研究探讨了与分娩干预和妊娠并发症的关系,特别是关注产妇差异中的剖腹产和难产。

方法

本研究使用了 2010 年至 2015 年期间的韩国 NHIS-NID 数据,对 1437186 名分娩妇女进行了分析。研究通过 2011 年卫生福利部确定的 50 个特定地区来定义产科服务不足地区。剖腹产通过使用医疗程序和 DRG 代码进行评估,而难产则通过使用 ICD-10 代码来定义。使用逻辑回归分析来检验相关性的显著性。

结果

在服务不足地区的人群中,在总共 1437186 人中,有 42873 人被确定。对于全国范围内的病例,剖腹产的比值比(OR)为 1.11(95%置信区间:1.08-1.13),难产的 OR 为 1.07(95%置信区间:1.05-1.09)。在相对容易获得产科服务的城市地区,根据是否属于产科服务不足地区,剖腹产和难产的 OR 分别为 1.16(95%置信区间:1.13-1.18)和 1.10(95%置信区间:1.08-1.19)。

结论

产妇保健设施的可及性差与高危妊娠密切相关,包括难产发生率增加和剖腹产率升高。产妇保健的不足不仅增加了严重妊娠并发症的风险。因此,迫切需要多方面的努力来缩小这一差距。

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本文引用的文献

1
Maternity care crisis worsening across the USA.美国各地的孕产妇护理危机日益恶化。
Lancet. 2023 Nov 25;402(10416):1956-1957. doi: 10.1016/S0140-6736(23)02616-8.
2
Risk factors of caesarean deliveries in urban-rural areas of Bangladesh.孟加拉国城乡地区剖宫产的风险因素。
Front Reprod Health. 2023 Feb 15;5:1101400. doi: 10.3389/frph.2023.1101400. eCollection 2023.

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