• 文献检索
  • 文档翻译
  • 深度研究
  • 学术资讯
  • Suppr Zotero 插件Zotero 插件
  • 邀请有礼
  • 套餐&价格
  • 历史记录
应用&插件
Suppr Zotero 插件Zotero 插件浏览器插件Mac 客户端Windows 客户端微信小程序
定价
高级版会员购买积分包购买API积分包
服务
文献检索文档翻译深度研究API 文档MCP 服务
关于我们
关于 Suppr公司介绍联系我们用户协议隐私条款
关注我们

Suppr 超能文献

核心技术专利：CN118964589B侵权必究
粤ICP备2023148730 号-1Suppr @ 2026

文献检索

告别复杂PubMed语法，用中文像聊天一样搜索，搜遍4000万医学文献。AI智能推荐，让科研检索更轻松。

立即免费搜索

文件翻译

保留排版，准确专业，支持PDF/Word/PPT等文件格式，支持 12+语言互译。

免费翻译文档

深度研究

AI帮你快速写综述，25分钟生成高质量综述，智能提取关键信息，辅助科研写作。

立即免费体验

围产期保健区域化及特定机构干预措施的有效性：一项系统评价

The Effectiveness of Regionalization of Perinatal Care and Specific Facility-Based Interventions: A Systematic Review.

作者信息

Ali Ayesha Arshad, Naseem Hamna Amir, Allahuddin Zoha, Yasin Rahima, Azhar Maha, Hanif Sawera, Das Jai K, Bhutta Zulfiqar A

机构信息

Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.

Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.

出版信息

Neonatology. 2025;122(Suppl 1):245-261. doi: 10.1159/000541384. Epub 2024 Nov 6.

DOI:10.1159/000541384
PMID:39504943
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11875419/
Abstract

INTRODUCTION

Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal 3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource-limited settings.

METHODS

A systematic review on effectiveness of perinatal care regionalization was updated, and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity building, and incentive packages. Search was conducted in relevant databases and meta-analysis conducted on Review Manager 5.4. We conducted subgroup analysis for evidence from low- and middle-income countries (LMICs).

RESULTS

Implementation of regionalization programs significantly decreased maternal mortality in LMICs (OR: 0.43; 95% CI: 0.34-0.55, 2 studies), stillbirth overall (OR: 0.70; 95% CI: 0.54-0.89, 5 studies), perinatal mortality overall (OR: 0.54; 95% CI: 0.5-0.58, 2 studies), and LMICs (OR: 0.54; 95% CI: 0.50-0.58, 1 study). Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40-0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66-0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15-9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61-0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44-0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03-1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22-5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21-0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45-0.95) in LMICs. Maternal education significantly decreased neonatal mortality (RR: 0.75; 95% CI: 0.66-0.84, 2 studies), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), and stillbirth (RR: 0.61; 95% CI: 0.45-0.82, 1 study). Capacity-building interventions significantly decreased maternal mortality in LMICs (OR: 0.37; 95% CI: 0.29-0.46, 5 studies), neonatal mortality overall (OR: 0.72; 95% CI: 0.53-0.98, 4 studies) and in LMICs (OR: 0.63; 95% CI: 0.54-0.74, 3 studies, and RR: 0.61; 95% CI: 0.48-0.79, 3 studies), perinatal mortality (OR: 0.53; 95% CI: 0.45-0.62, 2 studies, and RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (OR: 0.50; 95% CI: 0.43-0.59, 1 study, and RR: 0.79; 95% CI: 0.65-0.96, 1 study), under-5 mortality (RR: 0.79; 95% CI: 0.66-0.94, 1 study), and stillbirth in LMICs (OR: 0.71; 95% CI: 0.62-0.82, 4 studies), and preterm birth overall (OR: 0.39; 95% CI: 0.19-0.81, 1 study).

CONCLUSION

Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings.

INTRODUCTION

Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal 3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource-limited settings.

METHODS

A systematic review on effectiveness of perinatal care regionalization was updated, and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity building, and incentive packages. Search was conducted in relevant databases and meta-analysis conducted on Review Manager 5.4. We conducted subgroup analysis for evidence from low- and middle-income countries (LMICs).

RESULTS

Implementation of regionalization programs significantly decreased maternal mortality in LMICs (OR: 0.43; 95% CI: 0.34-0.55, 2 studies), stillbirth overall (OR: 0.70; 95% CI: 0.54-0.89, 5 studies), perinatal mortality overall (OR: 0.54; 95% CI: 0.5-0.58, 2 studies), and LMICs (OR: 0.54; 95% CI: 0.50-0.58, 1 study). Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40-0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66-0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15-9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61-0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44-0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03-1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22-5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21-0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45-0.95) in LMICs. Maternal education significantly decreased neonatal mortality (RR: 0.75; 95% CI: 0.66-0.84, 2 studies), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), and stillbirth (RR: 0.61; 95% CI: 0.45-0.82, 1 study). Capacity-building interventions significantly decreased maternal mortality in LMICs (OR: 0.37; 95% CI: 0.29-0.46, 5 studies), neonatal mortality overall (OR: 0.72; 95% CI: 0.53-0.98, 4 studies) and in LMICs (OR: 0.63; 95% CI: 0.54-0.74, 3 studies, and RR: 0.61; 95% CI: 0.48-0.79, 3 studies), perinatal mortality (OR: 0.53; 95% CI: 0.45-0.62, 2 studies, and RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (OR: 0.50; 95% CI: 0.43-0.59, 1 study, and RR: 0.79; 95% CI: 0.65-0.96, 1 study), under-5 mortality (RR: 0.79; 95% CI: 0.66-0.94, 1 study), and stillbirth in LMICs (OR: 0.71; 95% CI: 0.62-0.82, 4 studies), and preterm birth overall (OR: 0.39; 95% CI: 0.19-0.81, 1 study).

CONCLUSION

Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings.

摘要

引言

提供并利用适当的围产期护理对于提高孕产妇和新生儿存活率以及实现可持续发展目标3至关重要。确保医疗基础设施以及专业人员的可及性，有可能在全球范围内以及资源有限的环境中帮助改善孕产妇和新生儿结局。

方法

对围产期护理区域化的有效性进行了系统综述更新，并对基于机构的干预措施进行了新的综述，以提高产后护理覆盖率和改善结局。通过文献综述确定干预措施，包括交通、移动健康、远程医疗、孕产妇教育、能力建设和激励措施。在相关数据库中进行检索，并使用Review Manager 5.4进行荟萃分析。我们对来自低收入和中等收入国家（LMICs）的证据进行了亚组分析。

结果

区域化项目的实施显著降低了低收入和中等收入国家的孕产妇死亡率（比值比：0.43；95%置信区间：0.34 - 0.55，2项研究）、总体死产率（比值比：0.70；95%置信区间：0.54 - 0.89，5项研究）、总体围产儿死亡率（比值比：0.54；95%置信区间：0.5 - 0.58，2项研究）以及低收入和中等收入国家的围产儿死亡率（比值比：0.54；95%置信区间：0.50 - 0.58，1项研究）。与交通相关的干预措施显著降低了总体孕产妇死亡率（比值比：0.55；95%置信区间：0.40 - 0.74，1项研究）、新生儿死亡率（风险比：0.76；95%置信区间：0.66 - 0.88，1项研究）、围产儿死亡率（风险比：0.86；95%置信区间：0.77 - 0.95，1项研究），并提高了低收入和中等收入国家的产后护理覆盖率（比值比：6.89；95%置信区间：5.15 - 9.21，1项研究）。增加产院/产房显著降低了低收入和中等收入国家的死产率（比值比：0.75；95%置信区间：0.61 - 0.93，1项研究）。产后护理激励措施显著改善了低收入和中等收入国家的婴儿死亡率（风险比：0.79；95%置信区间：0.65 - 0.96，1项研究）、死产率（比值比：0.60；95%置信区间：0.44 - 0.83，1项研究）以及产后护理覆盖率（风险比：1.13；95%置信区间：1.03 - 1.25，1项研究）。远程医疗显著提高了低收入和中等收入国家的产后护理覆盖率（风险比：2.54；95%置信区间：1.22 - 5.28，3项研究），并降低了低收入和中等收入国家的孕产妇死亡率（比值比：0.46；95%置信区间：0.21 - 0.98，1项研究）和婴儿死亡率（比值比：0.65；95%置信区间：0.45 - 0.95）。孕产妇教育显著降低了新生儿死亡率（风险比：0.75；95%置信区间：0.66 - 0.84，2项研究）、围产儿死亡率（风险比：0.86；95%置信区间：0.77 - 0.95，1项研究）、婴儿死亡率（风险比：0.79；95%置信区间：0.65 - 0.96，1项研究）以及死产率（风险比：0.61；95%置信区间：0.45 - 0.82，1项研究）。能力建设干预措施显著降低了低收入和中等收入国家的孕产妇死亡率（比值比：0.37；95%置信区间：0.29 - 0.46，5项研究）、总体新生儿死亡率（比值比：0.72；95%置信区间：0.53 - 0.98，4项研究）以及低收入和中等收入国家的新生儿死亡率（比值比：0.63；95%置信区间：0.54 - 0.74，3项研究，风险比：0.61；95%置信区间：0.48 - 0.79，3项研究）、围产儿死亡率（比值比：0.53；95%置信区间：0.45 - 0.62，2项研究，风险比：

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a818/11875419/e8b3f03c1c47/neo-2025-0122-00s1-541384_F02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a818/11875419/484253645689/neo-2025-0122-00s1-541384_F01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a818/11875419/e8b3f03c1c47/neo-2025-0122-00s1-541384_F02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a818/11875419/484253645689/neo-2025-0122-00s1-541384_F01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a818/11875419/e8b3f03c1c47/neo-2025-0122-00s1-541384_F02.jpg

相似文献

1
The Effectiveness of Regionalization of Perinatal Care and Specific Facility-Based Interventions: A Systematic Review.围产期保健区域化及特定机构干预措施的有效性：一项系统评价
Neonatology. 2025;122(Suppl 1):245-261. doi: 10.1159/000541384. Epub 2024 Nov 6.
2
Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes.基于社区的干预方案，用于降低孕产妇和新生儿发病率及死亡率，并改善新生儿结局。
Cochrane Database Syst Rev. 2015 Mar 23;2015(3):CD007754. doi: 10.1002/14651858.CD007754.pub3.
3
Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes.为改善孕产妇和新生儿结局而激励女性增加产前检查的使用。
Cochrane Database Syst Rev. 2015 Dec 15;2015(12):CD009916. doi: 10.1002/14651858.CD009916.pub2.
4
Prenatal interventions for congenital diaphragmatic hernia for improving outcomes.用于改善先天性膈疝预后的产前干预措施。
Cochrane Database Syst Rev. 2015 Nov 27;2015(11):CD008925. doi: 10.1002/14651858.CD008925.pub2.
5
Multiple-micronutrient supplementation for women during pregnancy.孕期女性的多种微量营养素补充
Cochrane Database Syst Rev. 2017 Apr 13;4(4):CD004905. doi: 10.1002/14651858.CD004905.pub5.
6
Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes.基于社区的干预措施包，用于降低孕产妇和新生儿发病率及死亡率，并改善新生儿结局。
Cochrane Database Syst Rev. 2010 Nov 10(11):CD007754. doi: 10.1002/14651858.CD007754.pub2.
7
Antenatal dietary education and supplementation to increase energy and protein intake.产前饮食教育与补充，以增加能量和蛋白质摄入量。
Cochrane Database Syst Rev. 2015 Jun 2(6):CD000032. doi: 10.1002/14651858.CD000032.pub3.
8
Psychosocial interventions for supporting women to stop smoking in pregnancy.支持孕期女性戒烟的心理社会干预措施。
Cochrane Database Syst Rev. 2017 Feb 14;2(2):CD001055. doi: 10.1002/14651858.CD001055.pub5.
9
Effects of mHealth Interventions on Improving Antenatal Care Visits and Skilled Delivery Care in Low- and Middle-Income Countries: Systematic Review and Meta-analysis.移动医疗干预对改善中低收入国家产前保健就诊和熟练分娩护理的效果：系统评价和荟萃分析。
J Med Internet Res. 2022 Apr 22;24(4):e34061. doi: 10.2196/34061.
10
Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health.基于不同风险特征和环境进行妊娠期糖尿病筛查以改善母婴健康。
Cochrane Database Syst Rev. 2017 Aug 3;8(8):CD007222. doi: 10.1002/14651858.CD007222.pub4.

引用本文的文献

1
Neonatal Care in Low- and Middle-Income Countries: A Fresh Look.低收入和中等收入国家的新生儿护理：新视角
Neonatology. 2025;122(Suppl 1):1-4. doi: 10.1159/000543956. Epub 2025 Feb 4.
2
A Survey on the Organization and Operation of Level II/III Neonatal Intensive Care Units in Greece: A Comparison Between 2004 and 2022.希腊二级/三级新生儿重症监护病房的组织与运营调查：2004年与2022年的比较
Children (Basel). 2025 Jan 13;12(1):85. doi: 10.3390/children12010085.

本文引用的文献

1
Rationale and Approach to Evaluating Interventions for Newborn Care in Low- and Middle-Income Countries.低收入和中等收入国家新生儿护理干预措施评估的基本原理与方法
Neonatology. 2025;122(Suppl 1):5-12. doi: 10.1159/000542754. Epub 2024 Dec 9.
2
In France, the organization of perinatal care has a direct influence on the outcome of the mother and the newborn: Contribution from a French nationwide study.在法国，围产期护理的组织安排对母亲和新生儿的结局有直接影响：一项法国全国性研究的贡献。
Int J Gynaecol Obstet. 2024 Jan;164(1):210-218. doi: 10.1002/ijgo.15004. Epub 2023 Jul 24.
3
Maternal mortality, stillbirths, and neonatal mortality: a transition model based on analyses of 151 countries.
孕产妇死亡率、死产率和新生儿死亡率：基于对 151 个国家的分析的过渡模型。
Lancet Glob Health. 2023 Jul;11(7):e1024-e1031. doi: 10.1016/S2214-109X(23)00195-X.
4
Randomized Controlled Trial of a Mobile Health Application Based on Roy's Adaptation Model on Postpartum Adaptation.基于罗伊适应模式的移动健康应用对产后适应的随机对照试验
Nurs Res. 2023;72(3):E16-E24. doi: 10.1097/NNR.0000000000000647. Epub 2023 Feb 21.
5
Using the teach-back method to improve postpartum maternal-infant health among women with limited maternal health literacy: a randomized controlled study.运用回授教学法提高低健康素养产妇母婴健康水平：一项随机对照研究。
BMC Pregnancy Childbirth. 2023 Jan 9;23(1):13. doi: 10.1186/s12884-022-05302-w.
6
Evaluation of a comprehensive maternal newborn health intervention in rural Tanzania: single-arm pre-post coverage survey results.坦桑尼亚农村地区一项综合性孕产妇新生儿健康干预措施的评估：单组前后覆盖情况调查结果
Glob Health Action. 2022 Dec 31;15(1):2137281. doi: 10.1080/16549716.2022.2137281.
7
Effectiveness of adjunct telephone-based postnatal care on maternal and infant illness in the Greater Accra Region, Ghana: a randomized controlled trial.加纳大阿克拉地区基于电话的产后辅助护理对母婴疾病的有效性：一项随机对照试验。
BMC Pregnancy Childbirth. 2022 Oct 29;22(1):800. doi: 10.1186/s12884-022-05138-4.
8
Effectiveness of early essential newborn care implementation in four counties of western China.中国西部四个县实施早期基本新生儿护理的效果。
BMC Health Serv Res. 2022 Sep 21;22(1):1185. doi: 10.1186/s12913-022-08570-6.
9
mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review.降低撒哈拉以南非洲和南亚孕产妇及儿童死亡率的移动健康干预措施：一项系统文献综述。
Front Glob Womens Health. 2022 Aug 25;3:942146. doi: 10.3389/fgwh.2022.942146. eCollection 2022.
10
A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study.一项旨在改善印度北部产后健康状况的移动教育与社会支持小组干预措施：开发与可用性研究。
JMIR Form Res. 2022 Jun 29;6(6):e34087. doi: 10.2196/34087.