基层医院对流动人口妇女孕前优生检查与保健系统化管理的研究

Study on pre-pregnancy eugenics examinations and systematic management of migrant women in primary hospitals

目的探讨基层医院对流动人口妇女孕前优生检查与保健系统化管理模式的可行性。方法选取2017年1月～2018年5月广东省佛山市南海区"联安、河东"2个社区的流动人口妇女作为研究组(n=202),建立档案,进行本课题系统化管理。同期选取"平地、华夏"2个社区的流动人口妇女作为对照组(n=200),进行传统的孕前保健及管理,建立档案,定期电话随访并记录。比较分析两组样本项目实施前后对孕前保健知识及政策的知晓率;两组样本中确诊妊娠者(孕妇)均进入相同模式的产前管理,追踪比较两组孕妇孕期合并症及母婴并发症的发生情况;比较两组孕妇妊娠期疾病的总患病率;比较两组孕妇的产后出血量;比较两组孕妇的不同妊娠结局发生率。结果两组样本项目实施前的知晓率比较,差异无统计学意义(P>0.05);两组样本项目实施后的知晓率均高于项目实施前,差异有统计学意义(P<0.05);研究组样本项目实施后的知晓率均高于对照组,差异有统计学意义(P<0.05);研究组孕妇的妊娠期疾病总患病率明显低于对照组,差异有统计学意义(P<0.05);研究组孕妇(n=136)的产后出血量少于对照组孕妇(n=108),差异有统计学意义(P<0.05)。研究组孕妇的不同妊娠结局(早产流产、新生儿窒息、死胎及出生缺陷)发生率均低于对照组,差异有统计学意义(P<0.05)。结论运用切实可行并且具备基层特点的"多部门协作、多形式健康教育、制定保健计划"的系统化管理模式,真正加大宣传力度,强化管理,提高流动人口妇女主动参与孕前保健的意识,使得流动人口妇女孕前保健率真正得到提升。针对流动人口待孕育龄妇女,展开孕前优生诊断与保健服务,真正优化妊娠结果,实现流动人口优生优育的目标,使得人口素质水平得到提升,进而提升经济效益与社会价值。

Objective To investigate the feasibility of pre-pregnancy eugenics examination and systematic management of health care for migrant women in primary hospitals.Methods From January 2017 through May 2018,migrant women from “Lian′an and Hedong” communities of Nanhai District in Foshan City of Guangdong Province were enrolled as research group(n=202).The data were collected for the establishment of a file to carry out systematic management.Another batch of migrant women from “Pingdi and Huaxia”communities was enrolled at the same time as control group(n=200)for traditional pre-pregnancy care and management in a file.Regular telephone follow-up and record were necessary.The awareness rates of pre-pregnancy health care knowledge and policy before and after the implementation of the two samples were compared and analyzed.The confirmed pregnancies(pregnant woman)in both groups of samples entered the same pattern of prenatal management.The incidence of comorbidities during pregnancy and maternal and child complications were compared between the two groups.The total prevalence of gestational disease was compared between the two groups of pregnant women.Postpartum blood loss was compared between the two groups of pregnant women.The incidence of different pregnancy outcomes was compared between the two groups of pregnant women.Results There was no significant difference in awareness rate before project implementation of samples in the two groups(P>0.05).After implementation,the awareness rates of the two groups of samples were higher than those before the implementation of the project with statistical significance(P<0.05).The awareness rate of the samples after implementing the pregnant project in the research group was higher than that of the control group with a significant difference(P<0.05).The total prevalence of pregnancy diseases in pregnant women in the study group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).The amount of postpartum hemorrhage of the pregnant women in the study group(n=136)was less than that of the pregnant women in the control group(n=108),and the difference was statistically significant(P<0.05).The incidence of different pregnancy outcomes(premature abortion,neonatal asphyxia,stillbirth and birth defects)of the pregnant women in the study group were lower than those of the pregnant women in the control group,and the differences were statistically significant(P<0.05).Conclusion The systematic management mode of “multi-sectoral collaboration,multi-form health education,and health plan formulation” with practical and grassroots characteristics is used to promote publicity,strengthen management,and raise the awareness of women in floating populations to actively participate in pre-pregnancy care.Targeting on those to be pregnant women at childbearing age in the floating population,implementation of pre-pregnancy eugenics diagnosis and health care services can optimize the pregnancy outcomes,realize the goal of prepotency in the floating population,and improve the quality of population,thereby increasing economic and social values.