助产士咨询门诊干预下母婴结局的研究

Research on mother-infant prognosis of midwife consultation in clinic management

目的推行助产士门诊孕期体重干预流程以建立规范助产士咨询门诊模式;应用并验证惠氏孕期体重管理工具,对接受助产士咨询的每位孕妇进行体重管理,并建立个体化增重目标将孕期体重管理落实于临床实践以优化胎儿出生体重,以减少母亲和胎儿有不良预后。方法回顾性研究我科2010年7月～2012年7月应用Wyeth营养计算器软件进行体重管理的孕妇300例和未进行体重管理的孕妇300例,分别比较两组孕妇的顺产率、剖宫产、手术助产率、妊娠期糖尿病和妊娠期高血压疾病的发生率及新生儿窒息率、难产发生率、巨大儿发生率、FGR发生率。结果研究组顺产率、剖宫产、手术助产率、妊娠期糖尿病和妊娠期高血压疾病的发生率及新生儿窒息率、难产发生率、巨大儿发生率、FGR发生率均好于对照组,两组孕妇在顺产率、剖宫产率和巨大儿发生率之间有显著性差异(P<0.05),有统计学意义。结论助产士门诊有效增加产妇孕期知识、提高孕妇顺产率、剖宫产、降低孕妇妊娠期糖尿病和妊娠期高血压疾病的发生率及新生儿窒息率、难产发生率、巨大儿发生率、FGR发生率;助产士咨询门诊孕期体重管理机制效果良好,值得在临床上推广应用。

Objective To apply and verify the Wyeth pregnancy weight management tool,the midwife weight management to set up the standard of midwife consultation clinic model,establish individual weight gain during pregnancy weight management and to optimize the fetal birth weight,to reduce the poor prognosis of the mother and the fetus.Methods Retrospective studied 300 pregnant women with the application of Wyeth nutrition calculator software weight management,300 patients without weight management during 2010.7-2012.7.The incidence of cesarean section,surgical birth rate,gestational diabetes and gestational hypertension disease and neonatal asphyxia rate,dystocia incidence,fetal macrosomia incidence,FGR incidence were compared between the two groups.Results The experimental group was better than the control group in the cesarean section rate,the rate of dystocia,gestational disease incidence rate,the incidence of neonatal asphyxia and FGR and cesarean section rate;the rate of natural labour,dystocia and macrosomia between the two groups were significantly different（P0.05）.Conclusions Midwife outpatient service effectively increased maternal pregnancy knowledge,enhance the pregnant woman neonates,cesarean section,to reduce the pregnant women gestational diabetes and gestational hypertension disease incidence,neonatal asphyxia rate,dystocia incidence,great son incidence and FGR incidence;Midwife consultation clinic pregnancy weight management mechanism effect is good,it is worth popularization and application in clinic.