上海市江苏街道产妇产后访视及产后服务需求的现况调查

长宁区江苏社区卫生服务中心有专人负责产妇“产后访视”工作，指导产妇主动接受产后保健、科学育儿、产褥期保健，使产妇能顺利康复，使新生儿能健康成长。     

产褥期保健与母亲安全的关系

目的为了分析产褥期保健与母亲安全的关系。方法对河北省4个妇幼卫生项目县1990.1．1－1992．12．31死亡的全部孕产妇共87例，采用询问法进行了回顾性流行病学的调查。结果产褥期是孕产妇死亡的高发时期，产褥期死亡率为67.82％（59／87），比孕期死亡率17．24％（15／87）及分娩期死亡率14．94％（13／87）均明显增高。产褥期前三位死因为产后出血、产褥感染和妊娠合并心脏病。结论结合产褥期保健的要求提出防治产后出血、杜绝旧法接生、重视产妇营养、加强保健队伍的基本知识和基本技能训练、重视产后访视次数、质量及产妇的精神问题等措施是降低产褥期死亡率的重要措施。呼吁全社会共同努力，转变过去忽视产褥保健的观念。使妇女在产褥期从根本上获得生殖健康的权利。     

按需访视对降低产妇和新生儿疾病发病率的研究

为满足产妇、新生儿及家属的需求，降低产妇和新生儿常见疾病的发病率，改革访视制度，探讨按需访视在产妇和新生儿保健中的应用效果，我们于2003年1～6月，对189例产妇和189例新生儿实行按需访视，给予产妇和新生儿生理、心理、精神、社会等方面的关怀与指导，对家属进行产褥期保健和新生儿保健与护理知识宣教，在预防产妇和新生儿常见病的发生方面取得了满意效果。     

福建省社区产后访视质量调查研究

目的: 研究社区产后访视服务现状, 提高社区护理质量, 促进母婴健康。方法: 定量与定性研究相结合, 定量研究随机抽取福州市 5区内产后 42d左右的产妇 776例问卷调查, 定性研究采用专题小组讨论和半结构性访谈。产妇 12人参加专题讨论, 半结构性访谈 9人。结果: 产后访视率为 62. 9%, 按 3 ~4次标准进行的仅 4.3%~48 .2% 。社区产后访视内容中,询问母子一般情况达 98 .4%; 对产妇及新生儿体检的内容欠缺多; 进行母乳喂养指导为 94. 7%; 认为对产妇心理情绪状况“关心与非常关心”的占 28 7%, 对预防产后抑郁症的保健建议率占 9 9%; 对社区产后访视满意率不高为 33 .6% 。结论: 与产后访视的次数和内容的标准对照, 实际操作中的偏差是由于缺乏规范化的管理, 因此今后既要加快产后访视人员对产褥期护理与保健知识的更新, 拓展提供保健知识的内容, 又要在现有社区产后访视过程中, 加强规范化管理, 区级妇幼保健机构应对辖区内的社区产妇的产后访视工作实行面对面的质量评估问卷, 达到规范化管理的目的, 并采取针对性措施提高产后访视中的护理与保健质量。     

对398例产妇产后访视中开展健康教育的效果评价

目的通过社区产后访视进行健康教育,普及产褥期健康知识。方法产后访视人员在产妇出院后3—7天、生后15～20天各访视1次,比较产妇两次访视健康教育前后产褥期相关知识和技能掌握情况进行效果评价。结果产后访视进行健康教育前产妇掌握产褥期健康、新生儿护理知识、母乳喂养及产生性生活知识知晓率低于50％,按判定标准为不合格,健康教育后相关知识和技能明显提高,均超过90％,按判定标准为优秀。健康教育前后各项观察内容经x2检验,P〈0．01,有显著性差异。结论产后访视进行健康教育,可普及产褥期健康知识,促进产妇和新生儿身心健康。     

某社区产妇对“产后访视和健康教育”的需求分析

目的了解江苏街道产妇对"产后访视及健康教育"的需求意向,产妇对产后访视的内容和产后保健知识需求的形式和方向。方法采用随机抽样的方法,在本街道2006年分娩的产妇中,随机抽取80人次填写意向表。结果本街道产妇对产后访视的满意率达98.8%,能接受产后家访服务形式的产妇达100%,产妇的母乳喂养率达90.0%,需要接受更多保健知识的产妇达100%。结论对产妇进行产后保健、科学育儿、产褥期保健等一系列指导,使产妇能更顺利恢复到孕前的身体状况,使新生儿能够健康成长。     

国内产后家庭访视服务现状

<正>产褥期保健是孕产妇系统保健管理中一个重要的环节,通过访视医生的家庭访视,了解产妇康复、新生儿喂养情况及对产妇、婴儿体检,及时发现产妇、婴儿的一些异常情况,并予以处理及宣教指导,可以有效地提高母乳喂养率和降低产妇产后抑郁,对保护母婴健康安全、降低孕产妇死亡率和围产儿死亡率有重要意义,但目前国内的产后家庭访视服务现状并不十分乐观。     

产后访视在实际工作中的体会

目的探讨访视医生在产后访视中是为了全面了解产妇及新生儿的健康问题,促进母婴健康。方法对1656名产妇进行了上门访视,给予产妇及家属进行母乳喂养知识、健康教育及育儿知识进行宣教和指导。结论产后访视对产妇及婴儿实施连续性的健康服务,使产妇和家属掌握母乳喂养知识、新生儿护理、产褥期自我保健,预防疾病,保障母婴健康。     

社区健康服务中心开展产后访视工作的研究

目的:了解产妇及新生儿主要健康问题,分析产妇参加产前系统管理、接受产后访视和产褥期状况的影响因素,总结社区健康服务中心开展产后访视工作模式的优势和可行性。方法:2001年1月1日~12月31日,深圳市罗湖区共22家社区健康服务中心对休养地在罗湖区的产妇6 110人和新生儿6 135人进行了产后访视,对其健康状况进行统计、汇总,并在4家社区健康中心随机抽取213名产妇进行问卷调查,在Foxpro中建立数据库,采用SAS统计软件进行统计分析。结果:产褥期妇女的主要健康问题是乳汁分泌不足(17.89%),伤口愈合欠佳(6.07%);新生儿的主要异常情况是黄疸症状重或持续时间延长(8.43%),湿疹(4.37%)。抽样调查显示:①产妇的丈夫为教师、对访视工作的满意度高者,产妇接受产后访视的次数较多;②产妇为科技人员、丈夫为商业人员和个体者是产妇产褥期健康的危险因素;产妇和丈夫的文化程度高则是产妇参加产前系统管理的保护因素;产妇为阴道产、在产褥期适当运动、每天清洗会阴、定时开窗和产后访视次数多为产褥期健康的保护因素。结论:①产后母乳分泌不足、新生儿黄疸是母婴的主要健康问题,应采取综合措施,提高母乳喂养率;②严格掌握剖宫产指征,遏制不合理剖宫产的增加;③社区健康服务中心开展产后访视具有一定的优势和可行性;④运用社区妇幼保健服务新的管理模式,不断完善产后访视工作。     

苏州市39806例产后访视结果分析及对策

目的通过了解苏州市产后访视情况,分析目前产后访视工作中存在的问题,寻找对策,改进工作。方法对苏州市4区2014年1-12月39 806例产妇的产后访视资料进行分析。结果转卡率、访视率、产妇患病率、新生儿患病率各区间有差异。产妇患病率1.35%。乳腺疾病患病比例最高,高血压、感染性疾病分别排第二、三位,产褥期抑郁症患病率较低。新生儿患病率3.90%。病理性黄疸居首位,第二位是感染性疾病,第三位是皮肤黏膜问题。结论产褥期是母婴保健的重要时期,通过提高产后访视质量,加强宣传指导,从而降低产褥期母婴患病率,提高母婴健康水平。     

Receipt of Home Health Care After Early Discharge: Results from a National Managed Care Organization

Objectives: To determine the frequency of home visits during the postpartum period among women discharged within 24 hours after childbirth, to identify characteristics of women who received at least one home visit, and to examine whether a home visit was related to postpartum experiences. Method: Women who were enrolled in a Prudential HealthCare® plan and had a recent normal vaginal delivery completed a 15-minute telephone survey (N = 5201). Only women who were discharged within 24 hours after delivery were included in this analysis (N = 3121). Selected variables, including maternal characteristics, pregnancy-related and postpartum experiences, and social support factors, were compared for women who received visits and those who did not receive visits within two weeks after delivery. Results: Slightly more than 30% of women participating in the survey received at least one home health care visit within 2 weeks after delivery discharge. Women who received a home visit were more likely to be Black, employed, primaparous, enrolled in a health maintenance organization, or not living in the Southern United States. Compared with women who did not receive a home visit, women who received a visit were more likely to have their newborn receive a phenylketonuria test after discharge, receive a follow-up phone call or housekeeping service, and access to a 24-hour hotline. Conclusions: Managed care organizations as well as other organized systems of care should be focused on improving the quality of prenatal and postpartum services, and increasing satisfaction of women using these services.     

城市基本公共卫生服务项目实施过程情况分析

目的对基本公共卫生服务过程进行分析,获取其执行过程中存在的问题。方法对黑龙江、安徽和广东省29家社区卫生服务机构,采用深入访谈法和问卷调查进行数据收集。结果政府基本公共卫生服务经费拨款为15元/人的占51.72%;3个省社区平均每万人口数与公卫医师的配比为0.25、0.25、0.35,正式编制人员数仅占44.15%;在9项基本公共卫生服务中,建立居民健康档案、健康教育、老年人保健和慢性病管理的覆盖率达到了100%,慢性病患者的管理率仅约为40%及重性精神病管理率低于10%,新生儿访视率、孕产妇产前管理率和产后访视率均约为20%;居民对基本公共卫生服务项目的知晓率仅为42.62%。结论所调查社区卫生服务机构基本公共卫生服务项目开展不均衡,在"量"上取得显著成效,但在"质"上存在较多问题。     

不同户籍产妇孕产期保健状况调查

目的:了解北京市不同户籍产妇孕产期保健状况,为提高孕产期保健水平提供依据。方法:于2003年8～12月对北京市9所助产单位分娩的825例产妇进行问卷调查,其中本市户口产妇480例,外地户口产妇345例。结果:①本市产妇孕期平均产检次数(9.2±3.6)次,外地产妇(7.8±3.5)次(t=5.42,P=0.000)。本市和外地产妇进行产前检查与产妇的职业、文化水平、家庭经济条件和生育次数有关。②本市和外地产妇在产前检查过程中去医院感觉方便者占67.9%。③本市产妇孕妇学校的听课率为50.2%,外地产妇为34.8%(χ2=19.41,P=0.000)。④本市产妇剖宫产率59.4%,外地产妇为42.9%(χ2=21.85,P=0.000)。⑤本市和外地产妇愿意母乳喂养者占97.5%,产后2～7天母乳喂养者为86.8%。⑥本市产妇产后避孕方式知晓率为72.7%,外地产妇为55.4%(χ2=26.71,P=0.000)。结论:①流动人口妇女孕产期保健状况应予关注。②针对本市和外地产妇产前检查不便利、孕妇学校听过课比例较低、剖宫产率较高、产后避孕知识知晓率不高的共同特点,应充分利用孕妇学校加强产时分娩方式及产后避孕方式选择的宣教,提倡以孕产妇为中心的产科服务模式。     

妇女对产后访视服务的体验与需求

为了深入了解产后妇女对社区提供的产后访视服务的看法及对此项服务的需求 ,并由此提出改进现有产后访视服务的可能做法 ,在上海某中心城区的 2个街道深入访谈了 5 3名在 1998年 12月～ 1999年 7月期间接受过产后访视服务的妇女 ,并进行了 2组产后妇女的专题小组讨论。结果 :产后访视覆盖率达 10 0 % ,其中 9%的对象接受过 1次、32 %的对象接受过 2次、5 9%的对象接受过 3次产后访视。大多数产妇接受了产后访视常规中问诊、检查和宣教。在产妇所遇的问题中有关小儿护理的问题占第 1位 ,其次是产后妇女本人的情绪问题。产后妇女对与婴儿健康成长有关的服务内容需求最大 ,希望能从专业医护人员处获取可靠信息 ,有多种媒体的健康教育教材可供家庭选用 ,同时还呼吁在社区内有形式多样的面对面教育活动 ,如咨询、父母学校和母亲俱乐部等。研究结果提示产后访视服务现已有较满意的覆盖率 ,但其内容、形式和服务质量尚有待以服务对象需求为导向 ,在条件具备的情况下不断改善。     

佛山市某区1岁以下流动儿童保健服务利用与其母亲孕产期保健服务的相关性研究

目的 探讨1岁以下流动儿童保健服务利用与其母亲孕产期保健服务的相关性,为进一步提高流动儿童保健服务利用提出建议。方法 采用横断面调查,选取佛山市某区1岁以下流动儿童母亲579名为对象,对其进行面对面的问卷调查,利用二分类Logistic分析儿童系统管理与其母亲孕产期保健服务利用的相关性。结果 流动儿童保健服务利用现状为:儿童体检率89.1%,儿童系统管理率49.2%;流动儿童母亲孕产期保健服务利用现状为:产前检查率96.0%,孕早期检查率87.5%,≥5次产前检查率61.5%,住院分娩率99.7%,产后访视率37.3%,孕产妇系统管理率22.2%;多因素分析结果显示母亲产后访视、孕产期系统管理分别与儿童系统管理呈正相关(OR=2.017,95%CI=1.339~3.038;OR=1.941,95%CI=1.208~3.119)。结论 流动人口妇幼保健服务全程利用水平相对较低;母亲产后访视和孕产期系统管理是儿童系统管理的促进因素,提示母亲孕产期保健服务利用的改善可能有助于进一步提高儿童保健服务的利用。     

Improving maternal postpartum mental health screening guidelines requires assessment of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) has a prevalence of 4–17% in the postpartum period and, like better known postpartum depression (PPD), is linked to reduced quality maternal-child interactions, decreased maternal sense of life satisfaction and functioning, and negative impacts on child development. Currently, provincial and public health organizations throughout Canada screen new mothers for PPD with the Edinburgh Postpartum Depression Scale, which while laudable does not capture PTSD. PTSD is highly associated with PPD, 65% of women with PTSD also present with PPD, presenting a significant gap in postpartum maternal mental health screening. Numerous self-report PTSD screening questionnaires are available that could be incorporated into routine maternal postpartum mental health care. Furthermore, across Canada, regional differences in availability of maternal mental health screening, services, and programs suggest a gap in one of the tenets of Canadian health care—lack of universality. Not only does Canada require national maternal mental health screening, service and program guidelines, but PTSD screening must be incorporated, in order to identify and treat new mothers experiencing mental health problems.     

Factors associated with postpartum care among Massachusetts users of the Maternal and Infant Care Program

Records of the 21 Maternal and Infant Care (MIC) offices run by the Massachusetts Department of Public Health located in community-based facilities in high-risk areas provided data for the period 1985-87. MIC services include a postpartum visit within 2-6 weeks after birth. 24% of the deliveries in the MIC program were to teenagers. Unmarried women, high school dropouts, and minority group members were greatly overrepresented in the MIC program. 78% (10,854) of the women who received MIC care returned for a postpartum visit. Maternal age, educational status, parity, ethnicity, primary language, adequacy of prenatal care, length of maternal hospitalization, transfer of the infant to a neonatal intensive care unit, length of pregnancy, birth outcome, type of delivery, and birth weight were factors studied. The largest effect appeared to be correlated with adequacy of prenatal care utilization (the Kessner Index is used). Only 63% of women with inadequate utilization returned, compared with 76% of those with intermediate care and 86%, adequate care. The higher the women's level of education, the more likely she was to have a postpartum visit. The more children she had, the less likely she was to return. 82% of those with 1st births returned and 70% of those with 4 or more children. Women who did not speak English were more likely to return, (82%) than those who did (78%). NonEnglish speaking Asian women had the highest return rate (92%). Women under age 26 were likely to return than older ones. Factors associated with postpartum care were analyzed by year of delivery, so time trends could be seen. In 1985 and 1986, 78.9% returned for postpartum care; in 1987, the figure decreased to 76.4%. The % with adequate prenatal care who returned for postpartum care declined each year, from 87.4% in 1985 to 85.9% in 1986, and 83.8% in 1987. This was statistically significant. The % of Blacks who received postpartum care also declined, significantly. There was no change in the proportion getting adequate postpartum care among nonBlack groups. Factors associated with the lack of postpartum care in the multivariate analysis included Hispanic ethnicity, or later birth, and having a repeat cesarean section. The findings were shown to be stable across the years. In 1986 and 1987, women on the Healthy Start (a state-funded reimbursement program that pays for obstetric care of women with incomes between 100 and 185% of the poverty level) were less likely to miss their postpartum visit than those with commercial insurance.     

Smoking Cessation Intervention for Pregnant Women: A Call for Extension to the Postpartum Period

The association between smoking during pregnancy and adverse maternal/neonatal health outcomes is widely acknowledged, and recent health care reform has filled a much-needed gap by extending prenatal smoking cessation intervention coverage to all pregnant women on Medicaid. While more extensive coverage will improve quit rates during pregnancy, there continues to be a need to address high relapse rates in the postpartum period for both the insured and the uninsured. Smoking during the postpartum period exposes infants directly and indirectly to negative health effects, and has additional costs to mothers and society. Approximately 80% of women who quit smoking during pregnancy relapse in the first year postpartum, highlighting a need for effective continuing care that supports them through the challenging postpartum period when stress is high and motivations to stay quit may change. Existing relapse prevention interventions, typically delivered during pregnancy, have been found to be of little benefit during the postpartum period, suggesting the need for a more formal continuing care approach. Phone-based protocols are promising because they address the need for flexible access, and are known to be effective at increasing quit rates and sustained cessation.     

孕产妇保健服务利用现状调查

目的了解中国孕产妇保健服务需求和利用现状,探讨影响孕产妇保健服务利用的主要因素。方法应用自行设计的调查问卷对2009年7-12月间分娩的1 945名妇女进行调查,并对孕产妇保健服务利用的影响因素进行分析。结果孕早期系统保健管理卡建卡率为49.77%,产前保健指导率为82.98%,产后保健指导率为52.75%,产前检查率为99.33%,产前检查5次率为74.24%,住院分娩率为98.61%,产后访视率为42.21%,产后访视3次率为9.51%;影响孕产妇保健服务利用的因素主要有孕产妇年龄、职业、文化程度、就医距离、活产生育数、居住地以及婚姻状况等。结论孕产妇首次产前检查时间滞后,产后访视率低,孕产妇的孕期保健服务有待加强。