流动人口产前保健系统化管理效果分析

目的 调查上海市闵行区妇幼保健院实行＂流动人口产前保健系统化管理＂后流动人口孕产期保健情况.方法 收集2006年8月1日至31日闵行区505例流动人口产妇（观察组）,通过建立〈上海市孕产妇健康联系手册〉,调查分析产前保健现状、妊娠结局及影响因素,并与2004年7月至2005年6月＂外来孕妇与本地孕妇产前检查和妊娠结局的对照研究＂中收集的在分娩点及上海市第五人民医院产科住院分娩的3364例流动人口产妇（对照组）的保健情况比较.结果 产前检查次数1～3次者占32.1%（162例）,4～8次者占43.0%（217例）,≥9次者占15.6%（79例）,与对照组比较差异有统计学意义（P=0.001）.40.4%（185/458）的产前检查对象认为费用＂很贵或偏高＂.72.0%（211/293）因＂不清楚建册流程或不知道要建册＂而未建册.产妇学历（P=0.000）、丈夫是否沪籍（P=0.017）、准生证（P=0.002）、建立联系手册（P=0.002）与产前检查次数相关.结论 ＂流动人口产前保健系统化管理＂促进孕产期保健利用,免费建立联系手册是进一步提高产期保健利用的可行方法.

Systematic approach to management on prenatal care in floating population: effectiveness and proposal for improvement

Objective To investigate the effectiveness of system approach to management on prenatal health care in floating population. Methods The prenatal care was managed through establishing "Contact handbook on the health of pregnant women in Shanghai" for 505 lying-in women from the floating population of Minhang District. The condition of antenatal health care, the outcome of gestation and related factors were investigated and the results were compared to those reported in literatures. Results After system approach to management, the rate of having 1 - 3 antenatal examinations accounted for 32.1% ( 162/505 ), that of 4 - 8 examinations accounted for 43.0% ( 217/505 ), that ≥ 9 examinations accounted for 15.6% (79/505), which were higher than that reported by Zhuang Chanjuan (P = 0.001 ). Among 458 responders 185 (40.4% ) thought the cost for prenatal examination was "high" or "too high". Among 293 responders, 211 (72.0%) did not establish the contact handbook due to "not knowing the handbook" or "not clear about the process". The frequency of antenatal examination was associated with education levels of the lying-in women ( P =0.000) , whether their husbands being native Shanghainese or not ( P =0.002)and establishing contact handbood ( P = 0.002). Conclusions System approach to management promotes the utilization of antenatal health care for floating population, establishing contact handbook is a workable method to promote the utilization.