孕期、分娩期及产后的助产连续性护理：一项配对队列研究。
Midwifery Continuity of Care During Pregnancy, Birth, and the Postpartum Period: A Matched Cohort Study.
作者信息
Lundborg L, Åberg K, Liu X, Norman M, Stephansson O, Pettersson K, Ekborn M, Cnattingius S, Ahlberg M
机构信息
Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
出版信息
Birth. 2025 Mar;52(1):146-156. doi: 10.1111/birt.12875. Epub 2024 Oct 28.
OBJECTIVE
To compare pregnancy outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care in Sweden.
DESIGN
Matched cohort study.
SETTING
Public healthcare during pregnancy and childbirth, Stockholm, Sweden.
POPULATION
Women giving birth at Karolinska University Hospital site Huddinge in Stockholm between January 1, 2019, and August 31, 2021.
METHODS
Data on all births including MCoC and standard care, during the time period, were retrieved from the national Swedish Pregnancy Register. Propensity score matching was applied to obtain a matched set from the standard care group for every woman in the MCoC model. Based on the matched cohort, we estimated risk ratios (RR) for binary outcomes with 95% confidence intervals (CI).
MAIN OUTCOME MEASURES
Interventions during labor, mode of birth, and preterm birth (< 37 gestational weeks).
RESULTS
Compared with standard care, women in the MCoC model were more likely to give birth spontaneously (RR 1.06 95% CI 1.02-1.10) and less likely to have an elective cesarean on maternal request (RR 0.24 95% CI 0.11-0.51). The risk of preterm birth was also reduced in the MCoC group (RR 0.51 95% CI 0.32-0.82).
CONCLUSION
The MCoC model was associated with fewer medical interventions and improved pregnancy outcomes.
目的
比较瑞典助产士连续性照护（MCoC）模式与标准助产照护的妊娠结局。
设计
匹配队列研究。
地点
瑞典斯德哥尔摩孕期及分娩期间的公共医疗保健机构。
研究对象
2019年1月1日至2021年8月31日在瑞典斯德哥尔摩胡丁厄卡罗琳斯卡大学医院分娩的妇女。
方法
从瑞典国家妊娠登记处获取该时间段内所有分娩的数据，包括MCoC模式和标准照护的数据。应用倾向得分匹配法，为MCoC模式中的每位女性从标准照护组中获取一组匹配对象。基于匹配队列，我们估计了二元结局的风险比（RR）及95%置信区间（CI）。
主要结局指标
分娩期间的干预措施、分娩方式和早产（孕周<37周）。
结果
与标准照护相比，MCoC模式中的女性更有可能自然分娩（RR 1.06，95%CI 1.02 - 1.10），且因产妇要求进行选择性剖宫产的可能性较小（RR 0.24，95%CI 0.11 - 0.51）。MCoC组的早产风险也有所降低（RR 0.51，95%CI 0.32 - 0.82）。
结论
MCoC模式与较少的医疗干预和改善的妊娠结局相关。
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