Blomgren Johanna, Wells Michael B, Amongin Dinah, Erlandsson Kerstin, Wanyama John, Afrifa Diana A, Lindgren Helena
Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Solna, 171 77, Sweden.
Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
BMC Public Health. 2025 Jan 3;25(1):19. doi: 10.1186/s12889-024-21137-w.
Globally, the quality of maternal and newborn care remains inadequate, as seen through indicators like perineal injuries and low Apgar scores. While midwifery practices have the potential to improve care quality and health outcomes, there is a lack of evidence on how midwife-led initiatives, particularly those aimed at improving the use of dynamic birth positions, intrapartum support, and perineal protection, affect these outcomes.
To explore how the use of dynamic birth positions, intrapartum support, and perineal protection impact the incidence of perineal injuries and the 5-min Apgar score within the context of a midwife-led quality improvement intervention.
A cohort of 630 women with uncomplicated full-term pregnancies was recruited from a hospital in Uganda. Observations and questionnaires assessed birth positions, intrapartum support, perineal protection, health outcomes and maternal characteristics. Primary outcomes included perineal injuries and the 5-min Apgar scores. The primary outcomes were analysed using descriptive data, with trends visualised through a run chart to assess changes during the midwife-led Quality Improvement intervention. Secondary outcomes included postpartum haemorrhage, admission to neonatal intensive care, newborn resuscitation, skin-to-skin care, and breastfeeding initiation.
A statistically significant association was found between women having intact perineum (i.e., no perineal injuries) and giving birth in a dynamic birth position [AOR; 0.6 (95% CI 0.4 - 0.90)], receiving intrapartum support [AOR; 0.9 (95% CI 0.9 - 1.0)], and using perineal protection measures [AOR; 0.3 (95% CI 0.2 - 0.5)]. Newborns with an Apgar score below seven at five minutes were significantly associated with intrapartum support [AOR; 0.8 (95% CI 0.7 - 1.0)] and perineal protection [AOR; 0.3 (95% CI 0.1 - 0.8)]. However, after adjustment, no significant association was found between Apgar score and birth positions [AOR; 0.5 (95% CI 0.2 - 1.5)]. Perineal injuries and low Apgar scores significantly decreased (p < 0.001) during the Midwife-led Quality Improvement intervention period.
This study demonstrates that low 5-min Apgar scores and perineal injuries decreased during a midwife-led Quality Improvement intervention focusing on dynamic birth positions, intrapartum support, and perineal protection strategies.
This study is registered on ClinicalTrials.gov as of 14th February 2022, under registration number NCT05237375.
从会阴损伤和低阿氏评分等指标可以看出，全球范围内孕产妇和新生儿护理质量仍不尽如人意。虽然助产实践有潜力提高护理质量和改善健康结局，但缺乏证据表明以助产士为主导的举措，特别是那些旨在增加动态分娩姿势的使用、产时支持和会阴保护的举措，如何影响这些结局。
探讨在以助产士为主导的质量改进干预背景下，动态分娩姿势的使用、产时支持和会阴保护如何影响会阴损伤发生率和5分钟阿氏评分。
从乌干达一家医院招募了630名足月妊娠且无并发症的妇女。通过观察和问卷调查评估分娩姿势、产时支持、会阴保护、健康结局和产妇特征。主要结局包括会阴损伤和5分钟阿氏评分。使用描述性数据对主要结局进行分析，并通过运行图直观呈现趋势，以评估在以助产士为主导的质量改进干预期间的变化。次要结局包括产后出血、入住新生儿重症监护室、新生儿复苏、皮肤接触护理和开始母乳喂养。
发现会阴完整（即无会阴损伤）的妇女与采用动态分娩姿势分娩[AOR；0.6（95%CI 0.4 - 0.90）]、接受产时支持[AOR；0.9（95%CI 0.9 - 1.0）]以及采用会阴保护措施[AOR；0.3（95%CI 0.2 - 0.5）]之间存在统计学上的显著关联。5分钟时阿氏评分低于7分的新生儿与产时支持[AOR；0.8（95%CI 0.7 - 1.0）]和会阴保护[AOR；0.3（95%CI 0.1 - 0.8）]显著相关。然而，调整后，未发现阿氏评分与分娩姿势之间存在显著关联[AOR；0.5（95%CI 0.2 - 1.5）]。在以助产士为主导的质量改进干预期间，会阴损伤和低阿氏评分显著降低（p < 0.001）。
本研究表明，在以助产士为主导的聚焦于动态分娩姿势、产时支持和会阴保护策略的质量改进干预期间，5分钟低阿氏评分和会阴损伤有所减少。
本研究于2022年2月14日在ClinicalTrials.gov上注册，注册号为NCT05237375。
