Grylka-Baeschlin Susanne, Pauli Nadine, Rapp Catherine, Baumgartner Carola, Iseppi Clizia, Struebing Nele, Karg Linda, Minati Gabriela, Schäffer Leonhard, Lapaire Olav, Hodel Markus, Stocker Gabriella, Kimmich Nina, Sultan-Beyer Leila, Mueller Antonia Nathalie
Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
Division of Obstetrics and Prenatal Diagnostics, Cantonal Hospital of Baden, Baden, Switzerland.
PLoS One. 2025 May 27;20(5):e0322039. doi: 10.1371/journal.pone.0322039. eCollection 2025.
Nulliparous women in early labour are unsure when to go to hospital. The aim of this study was to develop and preliminary validate a tool for advising for or against hospital admission.
We developed the preliminary long version of the GebStart-tool with 32 items based on focus group discussions and a scoping review. It was applied in a multicentre study with n = 394 women during their contact with the hospital. Because of the formative and complex character of the GebStart-tool, factor analysis was not appropriate. Instead, items were subdivided deductively into the domains 'Physical symptoms', 'Emotional state', Self-management' and 'Resources'. Distribution of response options, adjusted Cox regressions with time intervals describing care needs as outcomes and adjusted multinomial regression with the outcome 'Care decision' were used to reduce items and for preliminary validation.
The reduced GebStart-tool contained 15 items and cutoff points at 22 and 33 points. The total score of the instrument was significantly associated with all time intervals describing care needs (duration between completion of the tool and hospital admission (HR = 1.08, 95% CI [1.05-1.10], p < 0.001), onset of active labour (HR = 1.06, 95% CI [1.04-1.08], p < 0.001), first use of medical pain management (HR = 1.08, 95% CI [1.06-1.11], p < 0.001), first use of alternative pain management (HR = 1.08, 95% CI [1.05-1.10], p < 0.001)). However, a higher total score of the reduced GebStart-tool was not significantly associated with a reduced risk for the decision 'Stay at home' (RR = 0.98, 95% CI [0.94-1.02], p = 0.421), but with a significantly higher risk for the decision 'Hospital admission' (RR = 1.13, 95% CI [1.05-1.22], p = 0.001) compared to 'Keep in contact'.
We developed a practical instrument with 15 items based on scientific evidence. Further research of the GebStart-tool in larger samples is necessary. Moreover, the use in clinical practice accompanied by implementation research and translation into other languages should be envisaged.
处于分娩早期的未生育女性不确定何时该去医院。本研究的目的是开发并初步验证一种用于建议是否入院的工具。
我们基于焦点小组讨论和范围综述，开发了包含32个条目的GebStart工具初步长版本。该工具在一项多中心研究中应用于n = 394名与医院接触的女性。由于GebStart工具具有形成性和复杂性，因子分析并不适用。取而代之的是，条目被演绎性地细分为“身体症状”“情绪状态”“自我管理”和“资源”几个领域。使用反应选项的分布、以描述护理需求的时间间隔为结果的调整后Cox回归以及以“护理决策”为结果的调整后多项回归来减少条目并进行初步验证。
简化后的GebStart工具包含15个条目，临界点分别为22分和33分。该工具的总分与描述护理需求的所有时间间隔均显著相关（完成工具填写至入院的时长（HR = 1.08，95% CI [1.05 - 1.10]，p < 0.001）、活跃期开始（HR = 1.06，95% CI [1.04 - 1.08]，p < 0.001）、首次使用药物止痛管理（HR = 1.08，95% CI [1.06 - 1.11]，p < 0.001）、首次使用替代止痛管理（HR = 1.08，95% CI [1.05 - 1.10]，p < 0.001））。然而，简化后的GebStart工具总分较高与“待在家中”决策风险降低并无显著关联（RR = 0.98，95% CI [0.94 - 1.02]，p = 0.421），但与“入院”决策风险显著升高相关（RR = 1.13，95% CI [1.05 - 1.22]，p = 0.001），与“保持联系”相比。
我们基于科学证据开发了一种包含15个条目的实用工具。有必要在更大样本中对GebStart工具进行进一步研究。此外，应设想在临床实践中的应用，并伴随实施研究以及翻译成其他语言。
