加拿大魁北克因纽特人转往三级中心分娩的转院指征和护理路径：2015-2019年回顾性病历。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada Pub Date : 2024-10-30 DOI:10.1016/j.jogc.2024.102709

Hilah Silver RN, BScN, PhD , Christina Antinora MD , Marianne Plourde MD , Ariane Bergeron MD , Lydia Mychaltchouk MD , Karen Wou MD , Neil Andersson MD, PhD

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引用次数: 0

摘要

目的：分娩后送是指将患者从农村和偏远社区转移到城市中心进行孕期保健或分娩，这可能与多种不良健康后果有关，并导致魁北克因纽特人和非土著居民之间的健康差距不断扩大。我们研究了从魁北克北部努纳维克转到南部三级医疗中心的因纽特人分娩后送的适应症和结果：一项为期五年的回顾性病历审查纳入了 2015 年至 2019 年期间转至三级医疗中心的 597 名因纽特人中有产科指征的 677 名孕妇：最常见的转院原因是糖尿病（70/677，10.3%）、高血压（69/677，10.2%）、产前筛查/软标记异常（57/677，8.4%）和早产威胁（55/677，8.1%）。在三级中心分娩的 534 名伊努伊特人（78.9%）中，84.1%（449/534）为阴道分娩。总体而言，27.0%（144/534）的产妇出现了产科并发症，其中最常见的是产后出血（58/534，10.9%）和胎盘滞留（34，6.37%）。在 549 名新生儿中，有 9 名死胎（1.6%），69 名新生儿（12.6%）需要入住新生儿重症监护室。约 3.4%（18/534）的产妇在产后出现并发症，最常见的并发症是受孕产物滞留（4/18，22.2%）和产后子痫前期（4/18，22.2%）：结论：努纳维克地区的因纽特人相对年轻且多产，他们有着独特的健康状况和护理需求。对努纳维克医疗保健能力的进一步投资，加上适合当地情况的、以预防为重点的围产期健康计划，可能会改善围产期健康状况，降低分娩后送率。

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Indications for Transfer and Care Pathways of Inuit Transferred to a Tertiary Centre for Childbirth in Québec, Canada: A Chart Review 2015–2019

Objectives

Childbirth evacuation, the transfer of patients from rural and remote communities to urban centres for pregnancy care or childbirth, can be associated with numerous adverse health outcomes and contributes to widening health disparities between Inuit and non-Indigenous populations in Québec. We examined the indications and outcomes of childbirth evacuations among Inuit from Nunavik, Northern Québec transferred to a southern tertiary care centre.

Methods

A 5-year retrospective chart review included 677 pregnancies of 597 Inuit with obstetric indications transferred to a tertiary care centre between 2015 and 2019.

Results

The most common reasons for transfer were diabetes (70/677, 10.3%), hypertension (69/677, 10.2%), abnormal prenatal screen/soft markers (57/677, 8.4%), and threatened preterm labour (55/677, 8.1%). Of the 534 (78.9%) Inuit who gave birth at the tertiary centre, 84.1% (449/534) were vaginal births. Overall, 27.0% (144/534) had obstetric complications, with postpartum hemorrhage (58/534, 10.9%) and retained placenta (34, 6.37%) being the most common. Of the 549 neonates, 9 were stillbirths (1.6%), and 69 neonates (12.6%) required admission to the neonatal intensive care unit. Approximately 3.4% (18/534) had complications within the postpartum period, with the most common being retained products of conception (4/18, 22.2%) and postpartum preeclampsia (4/18, 22.2%).

Conclusions

A relatively young and multiparous population, Inuit from Nunavik have unique health profiles and care needs. Further investment in health care capacity in Nunavik, alongside locally adapted, prevention-focused perinatal health programming, might improve perinatal health profiles and reduce the rates of childbirth evacuation.

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来源期刊

Journal of obstetrics and gynaecology Canada OBSTETRICS & GYNECOLOGY-

CiteScore

3.30

自引率

5.60%

发文量

302

审稿时长

32 days

期刊介绍： Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.