基层医院产后出血防治策略

Prevention and treatment strategies for postpartum hemorrhage in rural and county hospitals

基层医院规模小、人员少、急救药品、医疗设备等资源有限,对于产后出血的应急能力相对不足。文章对基层医院产后出血的防治提出了以下几点建议:(1)建立产后出血风险因素评估和管理的制度,根据自身条件确定转诊的指征,将高风险孕妇转至水平较高的医院进行孕期管理和分娩。(2)筛查妊娠期铁缺乏和贫血,通过饮食指导和药物治疗,提高孕期血红蛋白储备,减少产时输血率。(3)建立产科快速反应团队,确定启动快速反应团队的指征和紧急情况下可调动的医院资源,通过演练提高团队合作能力。(4)对于复杂产时并发症,应及时汇报高年资医生,评估是否需要多学科支持或转诊至上级医院,确保在出现紧急情况之前做好调动资源和人员的预案。(5)培训产科人员掌握二线止血方法。(6)定期进行产后出血的评审和反馈。

Rural and county hospitals are usually small scale,with fewer medical staff and limited resources such as emergency drugs and medical equipment,and thus face special challenges in the emergency management of postpartum hemorrhage.This article proposes the following suggestions for the prevention and treatment of postpartum hemorrhage in rural and county hospitals:(1)Establish a system for postpartum hemorrhage risk factor assessment,determine referral indications,and transfer high-risk pregnant women to higher-level hospitals for antennal care and delivery.(2)Screen and treat iron deficiency and anemia during pregnancy to improve hemoglobin reserves by diet guidance and drug treatment and reduce blood transfusion rates during childbirth.(3)Establish an obstetrical rapid response team,determine the indications for initiating the team and the hospital resources that can be mobilized in emergency situations,and improve team collaboration ability through drills.(4)For complex intrapartum complications,it is necessary to seek senior doctors' input without delay,evaluate whether multidisciplinary input or referral to higherlevel hospitals is needed,and ensure that resources and personnel mobilization plans are in place before emergency situations occur.(5)Train obstetric staff to master second-line hemostasis methods.(6)Implement regular clinical audit and provide feedback on postpartum hemorrhage.