三级产科病房的高危会诊多学科团队：病例患病率的变化
High-Risk Consult Multidisciplinary Team in a Tertiary Maternity Unit: Changing Prevalence of Cases.
作者信息
Ng Yang Huang Grace, Wright Ann, Ng Yvonne Yee Voon, Kavalloor Nirmal Visruthan, Tan Lay Kok, Quek Bin Huey, Tan Kok Hian
机构信息
Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
出版信息
J Multidiscip Healthc. 2025 Apr 11;18:2007-2017. doi: 10.2147/JMDH.S502995. eCollection 2025.
INTRODUCTION
The management of high-risk pregnancies requires coordinated expertise across multiple specialties. The High-Risk Consult (HRC) brings together a multidisciplinary team of specialists, including maternal-fetal medicine specialists, neonatologists, anaesthesiologists, and relevant subspecialities to provide comprehensive, individualized care for these complex pregnancies. While this model of care delivery is increasingly adopted worldwide, data on the prevalence and patterns within such multidisciplinary services remains limited.
OBJECTIVE
To describe the types of high-risk antenatal cases managed by an HRC and compare the prevalence of these conditions across two distinct time periods.
METHODS
This retrospective observational study analyzed all cases discussed at the HRC of a single tertiary center, KK Women's and Children's Hospital (KKH), in Singapore. Data were collected for two epochs: 1994-2003 and 2008-2021.
RESULTS
There were 2356 cases (with 4097 associated conditions) from 1994 to 2003 and 2514 cases (with 5944 conditions) from 2008 to 2021. These cases constituted 1.51% of 151,589 deliveries and 1.55% of 162,017 deliveries at KKH in the respective epochs. Despite an overall decrease in annual delivery rates over time, the proportion of high-risk cases remained stable. However, the prevalence of specific conditions changed significantly. The incidence of preterm rupture of membranes (17.6% vs 9.6%), preeclampsia (10% vs 4.8%), and preterm labor (12.6% vs 2.9%) decreased (all p < 0.0001), while fetal anomaly showed a marked increase (1.6% vs 14.5%; p < 0.0001).
CONCLUSION
The overall proportion of pregnancies requiring HRC consultation remained consistent at approximately 1.5% across both epochs, but there were notable shifts in the case composition. These findings highlight evolving priorities for multidisciplinary care and inform resource allocation and service planning in tertiary maternity units.
TRIAL REGISTRATION
CIRB Ref: 2022/2458.
引言
高危妊娠的管理需要多个专业的协调专业知识。高危会诊（HRC）汇聚了多学科专家团队，包括母胎医学专家、新生儿科医生、麻醉师以及相关亚专业医生，为这些复杂妊娠提供全面、个性化的护理。虽然这种护理模式在全球范围内越来越多地被采用，但关于此类多学科服务的患病率和模式的数据仍然有限。
目的
描述由高危会诊管理的高危产前病例类型，并比较两个不同时间段内这些情况的患病率。
方法
这项回顾性观察研究分析了新加坡单一首要中心——KK妇女儿童医院（KKH）的高危会诊中讨论的所有病例。收集了两个时期的数据：1994 - 2003年和2008 - 2021年。
结果
1994年至2003年有2356例病例（伴有4097种相关情况），2008年至2021年有2514例病例（伴有5944种情况）。这些病例分别占KKH在相应时期151,589例分娩的1.51%和162,017例分娩的1.55%。尽管随着时间的推移年分娩率总体下降，但高危病例的比例保持稳定。然而，特定情况的患病率发生了显著变化。胎膜早破的发生率（17.6%对9.6%）、子痫前期（10%对4.8%）和早产（12.6%对2.9%）下降（所有p<0.0001），而胎儿异常则显著增加（1.6%对14.5%；p<0.0001）。
结论
两个时期需要高危会诊的妊娠总体比例保持在约1.5%的一致水平，但病例构成有显著变化。这些发现突出了多学科护理不断变化的重点，并为三级产科单位的资源分配和服务规划提供了信息。
试验注册
CIRB编号：2022/2458 。
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