产后早期检查能否改善产妇健康：澳大利亚全科医疗随机试验的结果

Does an early postnatal check-up improve maternal health: results from a randomised trial in Australian general practice.

作者信息

Gunn J, Lumley J, Chondros P, Young D

机构信息

Department of General Practice and Public Health, University of Melbourne, Carlton, Australia.

出版信息

Br J Obstet Gynaecol. 1998 Sep;105(9):991-7. doi: 10.1111/j.1471-0528.1998.tb10263.x.

DOI:10.1111/j.1471-0528.1998.tb10263.x

PMID:9763051

Abstract

OBJECTIVES

To investigate whether a visit to a general practitioner one week after discharge results in less depression, increased breastfeeding rates, improved patient wellbeing, fewer physical problems and greater satisfaction with general practice care than the traditional six week postnatal check-up.

DESIGN

A randomised controlled trial.

SETTING

Rural and metropolitan Victoria, Australia. Population Women giving birth at one rural and one metropolitan hospital between February and December 1995 inclusive.

METHODS

All women received a letter and appointment date to see a general practitioner for a check-up: the intervention group for one week after hospital discharge, the control group for six weeks after birth. A mail-out survey was conducted at three and six months after birth, including Edinburgh Postnatal Depression Scale and Short Form 36.

RESULTS

1017/1407 (72.3%) women giving birth at participating hospitals were eligible for the trial: 683 (67.2%) gave informed consent. The average response rate to postal follow up at three and six months was 67.5%. No significant differences were found between the groups in: Edinburgh Postnatal Depression and Short Form 36 scores; number of problems; breastfeeding rates; or satisfaction with general practitioner care. Women in the intervention group were less likely to attend for their check-up (76.4% vs 88.4%; P = 0.001), more likely to discuss labour and birth at their check-up (OR= 1.77, 95% CI 1.17-2.68), less likely to have a vaginal examination (OR = 0.51; 95%, CI 0.34-0.77) or pap smear (OR = 0.34; 95% CI = 0.22-0.52) at their check; more likely to report difficulties with low milk supply (OR= 1.72; 95% CI = 1.12-2.66) and adjusting to the demands of a new baby (OR = 1.76; 95% CI 1.13 2.74), more likely to talk to a general practitioner about their baby (68.2% vs 58.0%; P=0.02) and less likely to consult a hospital doctor about their baby (7.3% vs 14.0%, P = 0.02).

CONCLUSIONS

To make clinically important improvements in maternal health more is required than early postnatal review.

摘要

目的

研究出院一周后拜访全科医生与传统的产后六周检查相比，是否能减少抑郁、提高母乳喂养率、改善患者健康状况、减少身体问题并提高对全科医疗护理的满意度。

设计

一项随机对照试验。

地点

澳大利亚维多利亚州的农村和城市地区。研究对象为1995年2月至12月期间在一家农村医院和一家城市医院分娩的妇女。

方法

所有妇女都收到了一封预约信，前往全科医生处进行检查：干预组在出院一周后进行检查，对照组在产后六周进行检查。在出生后三个月和六个月进行了一次邮寄调查，包括爱丁堡产后抑郁量表和36项简短健康调查问卷。

结果

在参与研究的医院分娩的1407名妇女中，1017名（72.3%）符合试验条件：683名（67.2%）给予了知情同意。在三个月和六个月时邮寄随访的平均回复率为67.5%。两组在以下方面未发现显著差异：爱丁堡产后抑郁量表和36项简短健康调查问卷得分；问题数量；母乳喂养率；或对全科医疗护理的满意度。干预组的妇女参加检查的可能性较小（76.4%对88.4%；P = 0.001），在检查时讨论分娩过程的可能性更大（比值比=1.77，95%置信区间1.17 - 2.68），在检查时进行阴道检查（比值比 = 0.51；95%置信区间0.34 - 0.77）或巴氏涂片检查（比值比 = 0.34；95%置信区间 = 0.22 - 0.52）的可能性较小；报告乳汁供应不足困难（比值比=1.72；95%置信区间 = 1.12 - 2.66）和适应新生儿需求困难（比值比 = 1.76；95%置信区间1.13 - 2.74）的可能性更大，与全科医生谈论宝宝的可能性更大（68.2%对58.0%；P = 0.02），就宝宝问题咨询医院医生的可能性更小（7.3%对14.0%，P = 0.02）。