Effect on birth outcomes of a formalised approach to care in hospital labour assessment units: international, randomised controlled trial.
BMJ
; 337: a1021, 2008 Aug 28.
Article
em En
| MEDLINE
| ID: mdl-18755762
ABSTRACT
OBJECTIVE:
To determine if a complex nursing and midwifery intervention in hospital labour assessment units would increase the likelihood of spontaneous vaginal birth and improve other maternal and neonatal outcomes.DESIGN:
Multicentre, randomised controlled trial with prognostic stratification by hospital.SETTING:
20 North American and UK hospitals.PARTICIPANTS:
5002 nulliparous women experiencing contractions but not in active labour; 2501 were allocated to structured care and 2501 to usual care.INTERVENTIONS:
Usual nursing or midwifery care or a minimum of one hour of care by a nurse or midwife trained in structured care, consisting of a formalised approach to assessment of and interventions for maternal emotional state, pain, and fetal position. MAIN OUTCOMEMEASURES:
Primary outcome was spontaneous vaginal birth. Other outcomes included intrapartum interventions, women's views of their care, and indicators of maternal and fetal health during hospital stay and 6-8 weeks after discharge.RESULTS:
Outcome data were obtained for 4996 women. The rate of spontaneous vaginal birth was 64.0% (n=1597) in the structured care group and 61.3% (n=1533) in the usual care group (odds ratio 1.12, 95% confidence interval 0.96 to 1.27). Fewer women allocated to structured care (n=403, 19.5%) rated staff helpfulness as less than very helpful than those allocated to usual care (n=544, 26.4%); odds ratio 0.67, 98.75% confidence interval 0.50 to 0.85. Fewer women allocated to structured care (n=233, 11.3%) were disappointed with the amount of attention received from staff than those allocated to usual care (n=407, 19.7%); odds ratio 0.51, 98.75% confidence interval 0.32 to 0.70. None of the other results met prespecified levels of statistical significance.CONCLUSION:
A structured approach to care in hospital labour assessment units increased satisfaction with care and was suggestive of a modest increase in the likelihood of spontaneous vaginal birth. Further study to strengthen the intervention is warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN16315180.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Cuidado Pré-Natal
/
Trabalho de Parto
/
Complicações do Trabalho de Parto
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Tocologia
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Enfermagem Obstétrica
Tipo de estudo:
Clinical_trials
Idioma:
En
Revista:
BMJ
Ano de publicação:
2008
Tipo de documento:
Article