BACKGROUND & AIMS: INTRODUCTION:Telecommunication infrastructure is being rolled out across Australia with little knowledge about the uptake by health professionals in remote areas. Computer mediated communication has the potential to offer educational support to remote practitioners; however, the viability of this is uncertain. The aim of this research was to establish and evaluate an internet-based resource library targeting the needs of remote area maternity service providers. METHODS:A participatory action research (PAR) approach was used to involve remote area maternity service providers in the Northern Territory of Australia. The evaluation of the resource library included its performance on reach, agency affiliation and richness, factors identified to affect the sustainability and utility of such a resource. An additional component of the evaluation framework documented the facilitators of and barriers to using an information technology strategy to reduce the isolation of remote area maternity service providers. RESULTS:Overall, the evaluation of the resource library was very positive. Feedback from the PAR team described the resource as contemporary, useful and relevant. Practitioners in leadership and education positions identified the resource library as a valuable tool that enabled them to access professional knowledge, which could then be distributed to any remote-based practitioners, who experienced difficulties with access themselves. The evaluation found that logistical issues were a major problem for potential users. Hardware inadequacies, access difficulties, unfamiliarity with computers, and a lack of management support for nursing and midwifery staff to utilise the resource, were all identified barriers. Remote-area practitioners highlighted education, training and 24 hour support as key priorities. CONCLUSIONS:Results from this research clearly showed the potential of web-based resources to offer educational support through access to clinical guidelines, reports and research, thus reducing the isolation of the remote practitioner. However, it highlighted the need for clear strategic direction at policy level, whereby all stakeholders unite to synchronise the rollout of information technology infrastructure with the necessary education, training and support as an integral component.

背景与目标：

BACKGROUND & AIMS: :This paper describes the maternity monitoring system in Botswana, developed in 1998, and the main methods used: maternal death and morbidity reviews at service delivery level, analysis by the National Maternal Mortality Audit Committee of data from the reviews as reported on two forms, perinatal reviews and surveys using process indicators. We carried out a study of these findings to examine whether the system was working well. Surveys using process indicators in 2001 and 2006 were analysed. Other data examined were from 2004-2006 and early 2007. The Maternal Death Notification Form was found to be comprehensive but not all health facilities were submitting them and some gave incomplete information. In 2001, 70% of pregnant women attended antenatal care but access to emergency obstetric care was uneven. In 2006, 28 facilities with maternity services surveyed were providing 24-hour delivery care, but laboratory, theatre and blood supplies were more limited, and only 50% of doctors and 67% of midwives had life-saving skills. Antibiotics were widely available, but there were shortages of magnesium sulphate, diazepam, oxytocics and manual vacuum aspiration kits. Recommendations for improvements have been made, training for skilled attendants is ongoing and a medical school has just opened at the University of Botswana.

背景与目标： : 本文介绍了1998年开发的博茨瓦纳产妇监测系统，以及所使用的主要方法: 在提供服务的层面进行孕产妇死亡和发病率审查，国家孕产妇死亡率审计委员会对审查数据的分析，这些数据报告有两种形式，围产期审查和使用过程指标的调查。我们对这些发现进行了研究，以检查该系统是否运行良好。使用过程指标2001年和2006进行了调查分析。检查的其他数据来自2004-2006和2007年。产妇死亡通知表被认为是全面的，但并非所有卫生机构都在提交，有些机构提供的信息不完整。2001年，70% 的孕妇接受了产前护理，但获得紧急产科护理的机会并不均衡。2006年，接受调查的28个提供产妇服务的机构提供24小时分娩护理，但实验室、剧院和血液供应较为有限，只有50% 的医生和67% 的助产士具有救生技能。抗生素广泛使用，但缺乏硫酸镁，地西epa，催产素和手动真空抽吸套件。已经提出了改进建议，正在对熟练的服务员进行培训，博茨瓦纳大学刚刚开设了一所医学院。

BACKGROUND & AIMS: AIM:Research on life circumstances, quality of life (QOL) and coping behavior in mothers with multiple sclerosis (MS). METHOD:Anonymous standardised questionnaire sent to 7,050 members of a section of the German MS Association (response rate 44.8%). Comparison of 482 mothers with MS (children aged < 18 years) with 607 childless women with MS. RESULTS:No statistically significant differences concerning age, MS course, complaints or number of exacerbations. Mothers with MS more frequently had a relationship, a higher monthly net income, were less employed, EDSS-score was lower and disease duration shorter. In QOL mothers with MS showed better social aspects even after multivariate adjustment for sociodemographic and disease-related variables. Influencing parameters on the social area of QOL were employment status, age, monthly household net income and disability. In their coping behavior mothers tended more to "religiosity/search for sense in life". CONCLUSION:There were several differences in sociodemographic data, QOL and coping behavior factors between mothers and childless women with MS. However, if motherhood itself has an influence on QOL and coping can not be derived from our data but there are some hints that motherhood seems to be no potential problem for living with the disease. Further research upon this topic is needed.

背景与目标：

BACKGROUND & AIMS: :This study was designed to evaluate the effect of maternity care by skilled providers on the occurrence of adverse pregnancy outcomes. A community-based cohort study was conducted at Dabat district, northwest Ethiopia, from December 1, 2011 to August 31, 2012. During the study period, 763 pregnant women were registered and followed until 42 days of their postpartum period. Use of skilled maternal care was the exposure variable. Reductions in occurrence of serious complications or death (adverse pregnancy outcomes) were used as outcome indicators. Data was collected at four time points; first contact, during the 9th month of pregnancy, within 1 week after delivery and at 42 days of postpartum. The effects of the exposure variable were evaluated by controlling potential confounders using logistic regression. One hundred and fifty-three (21%) of the women encountered at least one obstetric complication or death during delivery and postpartum period. Hemorrhage and prolonged labor were the major types. Pregnancy outcomes for 41 women (5.6%) were fetal, neonatal, or maternal deaths. Four or more ANC (antenatal care) visits, <4 ANC visits and delivery by skilled attendant showed 25% (OR 0.75; 95% CI 0.25, 2.75), 9% (OR 0.91; 95% CI 0.43, 1.69) and 31% (OR 0.69; 95% CI 0.36, 1.33) reduction in the occurrence of adverse pregnancy outcomes, respectively. Skilled maternal care showed reduction in adverse pregnancy outcomes (complications and deaths). However, the associations were not significant. Improving the quality of maternity care services and ensuring continuum of care in the health care system are imperative for effective maternal health care in the study area.

背景与目标： : 本研究旨在评估熟练提供者对产妇护理对不良妊娠结局的影响。从2011年12月1日到2012年8月31日，在埃塞俄比亚西北部的达巴特区进行了一项基于社区的队列研究。在研究期间，763名孕妇被登记并随访至产后42天。使用熟练的产妇护理是暴露变量。严重并发症或死亡 (不良妊娠结局) 的减少被用作结局指标。在四个时间点收集数据; 在怀孕第9个月，分娩后1周内以及产后42天的首次接触。通过使用逻辑回归控制潜在的混杂因素来评估暴露变量的影响。一百五十三 (21%) 名妇女在分娩和产后期间遇到至少一种产科并发症或死亡。出血和长时间分娩是主要类型。41名妇女 (5.6%) 的妊娠结局为胎儿、新生儿或产妇死亡。四次或更多次ANC (产前护理) 访问，<4次ANC访问和技术人员的分娩显示25% (或0.75; 95% CI 0.25，2.75)，9% (或0.91; 95% CI 0.43，1.69) 和31% (或0.69; 95% CI 0.36，1.33) 分别减少不良妊娠结局的发生。熟练的孕产妇护理显示不良妊娠结局 (并发症和死亡) 减少。但是，这些关联并不重要。提高产妇保健服务的质量并确保保健系统中的连续护理对于在研究区域中有效地提供产妇保健至关重要。

BACKGROUND & AIMS: Two themes pervade the issue of women and addiction in the United Statesanger and blame directed at women who use alcohol and other drugs; and neglect and a consequent lack of appropriate treatment. Often the focus is on the addicted pregnant woman and the debate posits a woman's right to autonomy and privacy in opposition to the future child's right to be born free from harm. Others emphasize the tension between blaming individuals and holding the state accountable for provision of services. These conflicts have impeded the diagnosis of women with substance abuse problems, the availability of services and women's access to appropriate care.

背景与目标： 在美国，针对使用酒精和其他药物的妇女的愤怒和指责，两个主题贯穿于妇女和成瘾问题; 忽视和因此缺乏适当的治疗。通常，焦点集中在上瘾的孕妇上，辩论将妇女的自主权和隐私权与未来儿童不受伤害的出生权对立。其他人则强调指责个人与要求国家对提供服务负责之间的紧张关系。这些冲突阻碍了对患有药物滥用问题的妇女的诊断，服务的提供以及妇女获得适当护理的机会。

BACKGROUND & AIMS: TITLE:Outcome of multiple cesarean sections in a tertiary maternity hospital in the United Arab Emirates. OBJECTIVE:To describe the operative outcomes, clinical findings, maternal morbidity and neonatal outcome associated with increasing numbers of cesarean deliveries. DESIGN:Retrospective study. SETTING:Corniche Hospital, Abu Dhabi, United Arab Emirates. POPULATION:The study cohort was 1008 women giving birth by cesarean section who had previously undergone one or more cesarean sections, who had a singleton pregnancy, and who were not in labor. METHODS:A retrospective study was undertaken over the one-year period from January 2016 to December 2016. Women were divided into five groups according to number of previous cesarean sections. The first group comprised of women who had one previous cesarean section, the second group women who had two previous cesarean sections, the third group consequently three previous cesarean sections and the fourth group four previous cesarean sections, whereas in the fifth group women had previously five or more previous cesarean sections. The maternal and neonatal outcomes of the groups were retrospectively evaluated. RESULTS:The risks of placenta previa, placenta accreta, uterine dehiscence or rupture, postpartum hemorrhage, blood transfusion, bladder injury, lengths of operative time and hospital stay, and number of admissions to the high dependency unit increased with increasing numbers of previous cesarean sections. Women with five or more previous cesarean sections had a 10-fold increased risk of placenta previa (odds ratio [OR], 9.8; 95 % confidence interval [CI], 3.3-28.6), a 27 - fold increased risk of placenta accreta (OR, 26.5; 95 % CI, 4.2-166.3), and an 11-fold increased risk of uterine dehiscence or rupture (OR, 11.3; 95 % CI, 1.8-70.8). DISCUSSION:The results of our study indicate that serious maternal morbidity increases with increasing numbers of previous cesarean sections. Women planning large families should consider the risks of repeat cesarean sections when contemplating elective primary cesarean delivery or attempted vaginal birth after one previous cesarean section.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To determine the frequency of avoidable neonatal neurological damage. STUDY DESIGN:We carried out a retrospective study from January 1st to December 31st 2003, including all children transferred from a level I or II maternity unit for suspected neurological damage (SND). Only cases confirmed by a persistent abnormality on clinical examination, EEG, transfontanelle ultrasound scan, CT scan or cerebral MRI were retained. Each case was studied in detail by an expert committee and classified as "avoidable", "unavoidable" or "of indeterminate avoidability." The management of "avoidable" cases was analysed to identify potentially avoidable factors (PAFs): not taking into account a major risk factor (PAF1), diagnostic errors (PAF2), suboptimal decision to delivery interval (PAF3) and mechanical complications (PAF4). RESULTS:In total, 77 children were transferred for SND; two cases were excluded (inaccessible medical files). Forty of the 75 cases of SND included were confirmed: 29 were "avoidable", 8 were "unavoidable" and 3 were "of indeterminate avoidability". Analysis of the 29 avoidable cases identified 39 PAFs: 18 PAF1, 5 PAF2, 10 PAF3 and 6 PAF4. Five had no classifiable PAF (0 death), 11 children had one type of PAF (one death), 11 children had two types of PAF (3 deaths), 2 had three types of PAF (2 deaths). CONCLUSION:Three quarters of the confirmed cases of neurological damage occurring in levels I and II maternity units of the Aurore network in 2003 were avoidable. Five out of six cases resulting in early death involved several potentially avoidable factors.

背景与目标：

BACKGROUND & AIMS: :Objectives To explore women's decisional conflict in the pathway of prenatal screening and testing (PreST) in Finland and to evaluate a counseling service. Methods Self-completion surveys were conducted at two medical settings (screening and further testing) of PreST. Decisional Conflict Scale (DCS) was the main measure. Different types of statistical tests were used to compare women's decisional conflict at different medical settings of PreST, and before-after pre-test counseling. Multivariable linear regressions analyzed the influences of the medical settings and other factors on women's decisional conflict. Results Compared to women in population-based screening, women in further testing (before pre-test counseling) were more likely to feel well informed (P < 0.001), had increased values clarity (P < 0.001), but more likely experienced uncertainty (P = 0.040). Besides medical settings, maternal age, gravidity and previous experience of fetal aneuploidy significantly influenced decisional conflict. After counseling, screen-positive women felt better informed (P < 0.001), had increased values clarity (P < 0.001), perceived more support (P < 0.001), and had better decision certainty (P < 0.001) than before counseling. Conclusions Medical settings influence women's decisional conflict during PreST. Individual counseling is effective in improving screen-positive women's decisional conflict. This research adds knowledge and experience on developing decision-making supports across the pathway of PreST.

背景与目标： : 目的探讨芬兰妇女在产前筛查和检测 (prestt) 途径中的决策冲突，并评估咨询服务。方法在prestt的两个医疗机构 (筛查和进一步测试) 进行自我完成调查。决策冲突量表 (DCS) 是主要衡量标准。使用不同类型的统计测试来比较prestt的不同医疗环境以及测试前咨询后的女性决策冲突。多变量线性回归分析了医疗环境和其他因素对女性决策冲突的影响。结果与进行基于人群的筛查的女性相比，接受进一步测试 (在测试前咨询之前) 的女性更有可能感到信息灵通 (p  <  0.001)，值清晰度增加 (p  <  0.001)，但更有可能经历不确定性 (p   =   0.040)。除医疗环境外，孕产妇年龄，妊娠和以前的胎儿非整倍性经历也显着影响决策冲突。咨询后，屏幕阳性的女性比咨询前感觉更好 (p  <  0.001)，增加了价值观的清晰度 (p  <  0.001)，感觉到更多的支持 (p  <  0.001)，并且具有更好的决策确定性 (p  <  0.001)。结论医学环境影响女性在prett期间的决策冲突。个人咨询可有效改善屏幕阳性女性的决策冲突。这项研究增加了在prert整个过程中开发决策支持的知识和经验。

BACKGROUND & AIMS: BACKGROUND:Though effective treatment programs for severely malnourished children are available, mortality rate among children with acute malnutrition continue to rise and little is known about its long-term outcomes and potential predictors of its in-hospital and post-discharge mortality. The aim of this study was to assess the survival status and predictors for mortality in severely malnourished children admitted to Minia University Maternity and Children Hospital. METHODS:A retrospective cohort study which included 135 children under 5 years of age who were admitted to the nutrition rehabilitation ward with severe acute malnutrition (SAM) during the period from January to December 2018. Data were collected from the inpatient's hospital records and the children's parents/guardians were interviewed using a detailed structured questionnaire that inquired about demographic and socioeconomic variables. The logistic and Cox regressions were used to assess the factors associated with the SAM's mortality. RESULTS:A total of 135 children were enrolled into the study. Death rate during hospitalization was 9.6%. The survival rate at the end of the fourth week of admission was 82.4%. There were 6.7% post-discharge deaths among 104 alive discharged children which occurred within 8 weeks after discharge. The adjusted HRs (95% CIs) for total SAM deaths were 1.57 (1.10-2.99) in children < 12 vs ≥ 12 months old; 4.79 (2.23-6.10) in those with WAZ < -3SD, 2.99 (1.16-4.66) in those with edema at admission and 3.44 (1.07-9.86) in children with complications. The respective ORs (95%CIs) for in-hospital SAM deaths in the same groups of children were 2.64 (1.22-6.43), 8.10 (2.16-11.67), 3.04 (1.70-6.06) and 3.71 (1.59-6.78). The main predictor for the SAM's post-discharge mortality was illiteracy of mothers; the adjusted HR (95%CI) was 7.10 (1.58-31.93; p = 0.01). CONCLUSIONS:Age, WAZ, edema and complications at admission were predictors for both in-hospital and total SAM mortality, while mother's education contributed to the early post-discharge mortality. The identification of predictors for mortality is an important preliminary step for interventions aiming to reduce morbidity and mortality.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Although the overall rate of caesarean deliveries in India remains low, rates are higher in private than in public facilities. In a household survey in Delhi, for instance, more than half of women delivering in private facilities reported a caesarean section. Evidence suggests that not all caesarean sections are clinically necessary and may even increase morbidity. We present providers' perspectives of the reasons behind the high rates of caesarean births in private facilities, and possible solutions to counter the trend. METHODS:Fourteen in-depth interviews were conducted with high-end private sector obstetricians and other allied providers in Delhi and its neighbouring cities, Gurgaon and Ghaziabad. RESULTS:Respondents were of the common view that private sector caesarean rates were unreasonably high and perceived time and doctors' convenience as the foremost reasons. Financial incentives had an indirect effect on decision-making. Obstetricians felt that they must maintain high patient loads to be commercially successful. Many alluded to their busy working lives, which made it challenging for them to monitor every delivery individually. Besides fearing for patient safety in these situations, they were fearful of legal action if anything went wrong. A lack of context specific guidelines and inadequate support from junior staff and nurses exacerbated these problems. Maternal demand also played a role, as the consumer-provider relationship in private healthcare incentivised obstetricians to fulfil patient demands for caesarean section. Suggested solutions included more support, from either well-trained midwives and junior staff or using a 'shared practice' model; guidelines introduced by an Indian body; increased regulation within the sector and public disclosure of providers' caesarean rates. CONCLUSIONS:Commercial interests contribute indirectly to high caesarean rates, as solo obstetricians juggle the need to maintain high patient loads with inadequate support staff. Perceptions amongst providers and consumers of caesarean section as the 'safe' option have re-defined caesareans as the new 'normal', even for low-risk deliveries. At the policy level, guidelines and public disclosures, strong initiatives to develop professional midwifery, and increasing public awareness, could bring about a sustainable reduction in the present high rates.

背景与目标：

BACKGROUND & AIMS: :Vitamin A is essential for mother and child; however, vitamin A deficiency (VAD) remains a public health issue in various countries, affecting around 19 million pregnant women. In Brazil, the scarcity and inconsistency of data have prevented the prevalence and epidemiological status of VAD from being established. This study aimed to analyze vitamin A nutritional status in women receiving prenatal care at a reference center in northeastern Brazil. A cross-sectional study was conducted with a sample of 676 women. Serum retinol was measured by high-performance liquid chromatography. Subclinical infection was detected by measuring C-reactive protein (CRP). The World Health Organization criteria were used in the prevalence analysis, VAD classification level, and CRP effect evaluation. The prevalence of VAD (serum retinol <0.70 μmol/L) was 6.2% (95% confidence interval 4.5⁻8.3). In the univariate analysis, the variables significantly associated with VAD (p < 0.05) were having <12 years of schooling, being in the third trimester of pregnancy, and anemia. In the final multivariate model, the variables that remained significantly associated (p < 0.05) were being in the third trimester of pregnancy and anemia. VAD constituted a mild public health problem in this sample of pregnant women and was associated with the third trimester of pregnancy and maternal anemia.

背景与目标： : 维生素a对母亲和儿童至关重要; 然而，维生素a缺乏症 (VAD) 仍然是各国的公共卫生问题，影响了大约1900万名孕妇。在巴西，数据的匮乏和不一致阻碍了VAD的流行和流行病学状况的确立。这项研究旨在分析巴西东北部参考中心接受产前护理的妇女的维生素a营养状况。对676名妇女进行了横断面研究。通过高效液相色谱法测定血清视黄醇。通过测定C反应蛋白 (CRP) 检测亚临床感染。在患病率分析，VAD分类水平和CRP效果评估中使用了世界卫生组织标准。VAD (血清视黄醇 <0.70 μ mol/L) 的患病率为6.2% (95% 置信区间4.5 8.3)。在单变量分析中，与VAD显着相关的变量 (p < 0.05) 是教育 <12年，妊娠晚期和贫血。在最终的多变量模型中，仍然显着相关的变量 (p < 0.05) 是在妊娠和贫血的第三个月。在该孕妇样本中，VAD构成了轻度的公共卫生问题，并与妊娠晚期和孕产妇贫血有关。

BACKGROUND & AIMS: BACKGROUND:Few investigations have considered evaluating the effects of certain combinations of ward routines like swaddling of the baby and separation of mother and baby on infant variables such as neonatal weight loss. AIMS:To study the effect of different ward routines in respect to proximity to mother and type of infant apparel, on breastfeeding parameters (amount of ingested milk, volume of supplements, number of breastfeeds, total duration of breastfeeding time) day 4 after birth as well as recovery from neonatal weight loss and infant's weight on day 5. STUDY DESIGN AND SUBJECTS:In a randomized trial with factorial design four treatment groups including 176 mother-infant dyads were studied 25-120 min after birth. Randomized treatments focused on care routines administered to the infants after delivery and later in the maternity ward as well as to the type of clothing the infants received. Group 1 infants were placed skin-to-skin with their mothers after delivery, and had rooming-in while in the maternity ward. Group 2 infants were dressed and placed in their mothers' arms after delivery, and roomed-in with mothers in the maternity ward. Group 3 infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group 4 infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or clothed in baby attire. Breastfeeding parameters were documented during day 4 after birth. Infant's weight was measured daily. RESULTS:Babies who were kept in the nursery received significantly more formula and significantly less breast-milk, than did babies who roomed-in with their mothers. Swaddling did not influence the breastfeeding parameters measured. However, swaddled babies who had experienced a 2-h separation period after birth and then were reunited with their mothers tended to have a delayed recovery of weight loss compared to those infants who were exposed to the same treatment but dressed in clothes. Furthermore, swaddled babies who were kept in the nursery and received breast-milk supplements had a significantly delayed recovery of weight loss after birth when compared to those infants ingesting only breast-milk. On day 5, regression analyses of predicted weight gain in the exclusively breastfed infants indicated a significant increase per 100 ml breast-milk (59 g), compared to the predicted weight gain on day 5 per 100 ml supplements in the swaddled babies (14 g) (P=0.001). CONCLUSION:Supplements given to the infants in the nursery had a negative influence on the amount of milk ingested. In addition, supplement feeding or a short separation after birth when combined with swaddling was shown to have a negative consequence to infant weight gain.

背景与目标：

BACKGROUND & AIMS: :Survival and quality of life are improved for very preterm babies when delivery occurs in a maternity unit with on-site neonatal intensive care (level III unit). We investigated the impact of distance on the probability of delivering in such a unit for births before 32 weeks of gestation from 9 European regions with diverse perinatal health systems (the MOSAIC cohort). We analysed distances between women's homes, and the nearest level III in population quartiles, adjusting for maternal and pregnancy characteristics. Living farther away from a level III reduced access to specialised care everywhere; in some regions women residing in the fourth quartile were half as likely to deliver in level III units as those in the first. To improve regionalized perinatal care the spatial location of level III units should be taken into account.

背景与目标： : 当在现场新生儿重症监护病房 (III级病房) 分娩时，早产婴儿的存活率和生活质量得到改善。我们调查了距离对妊娠32周前分娩的可能性的影响，该分娩来自9个具有不同围产期卫生系统的欧洲地区 (MOSAIC队列)。我们分析了女性家庭之间的距离，以及人口四分位数中最接近的III级，并根据孕产妇和怀孕特征进行了调整。远离三级生活减少了各地获得专业护理的机会; 在某些地区，居住在第四个四分位数的妇女在三级单位分娩的可能性是第一个的一半。为了改善区域围产期护理，应考虑三级单位的空间位置。

BACKGROUND & AIMS: :The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) asked ACNM member midwives and ACOG Fellows with successful and sustainable collaborative practices between obstetricians and midwives to describe their care models in jointly written articles. This review analyzes 12 of the 60 articles submitted. Five main themes were identified: impetus for new collaboration, basic foundations of collaborative care, commitment to successful partnership, care integration, and health professions education in an interprofessional practice environment. The analysis provides evidence of the extent to which committed clinicians are working together to provide excellent, women-centered maternity care.

背景与目标： : 美国妇产科学院 (ACOG) 和美国助产士护士学院 (ACNM) 要求ACNM成员助产士和ACOG研究员在产科医生和助产士之间成功和可持续的合作实践，以共同撰写的文章描述他们的护理模式。这篇综述分析了提交的60篇文章中的12篇。确定了五个主要主题: 新合作的动力，协作护理的基本基础，对成功伙伴关系的承诺，护理整合以及在跨专业实践环境中的卫生专业教育。该分析提供了证据，证明有奉献精神的临床医生在多大程度上共同努力，以妇女为中心提供出色的产妇护理。

BACKGROUND & AIMS: :Since 2008, Greece suffers a severe economic crisis. Adverse health outcomes have been reported, but studies on perinatal health are sparse. We aimed to examine the impact of economic crisis on perinatal parameters during early and established crisis periods. Birth records of 14 923 neonates, born in a public maternity hospital from 2005-2014, were reviewed for maternal (age, delivery mode) and neonatal (gender, birthweight, gestational age) variables. Univariable analysis tested the association of study variables with time-periods 2005-2007, 2009-2011 and 2012-2014. Multivariable logistic regression analysis identified factors independently associated with low birthweight (LBW) (<2500 g), prematurity (<37 weeks) and caesarean section (CS). During 2012-2014, compared to 2005-2007, LBW rate increased from 8.4 to 10.5% (RR 1.16; 95%CI 1.01-1.33); prematurity from 9.7 to 11.2% (RR 1.09; 95%CI 0.96-1.24), comprising mainly late-preterm neonates; CS from 43.2 to 54.8% (RR 1.21; 95%CI 1.16-1.26). Maternal age ≥30 years was risk factor for LBW, prematurity and CS; LBW was additional risk factor for CS. However, LBW and CSs increased during the study period, independently of maternal age. In conclusion, impaired perinatal parameters, manifested by increasing maternal age, LBW, prematurity and CS rate, were observed during the years of economic decline, with possible adverse consequences for later health.

背景与目标： : 自2008年以来，希腊遭受了严重的经济危机。已经报道了不良的健康结果，但是关于围产期健康的研究很少。我们旨在研究经济危机在早期和既定危机时期对围产期参数的影响。回顾了2005-2014年在公立妇产医院出生的14名923新生儿的出生记录，以了解孕产妇 (年龄，分娩方式) 和新生儿 (性别，出生体重，胎龄) 变量。单变量分析测试了研究变量与时间段2005-2007，2009-2011和2012-2014的关联。多因素logistic回归分析确定了与低出生体重 (LBW) (<2500g)，早产 (<37周) 和剖腹产 (CS) 独立相关的因素。在2012-2014期间，与2005-2007相比，LBW率从8.4增加到10.5% (RR 1.16; 95% CI 1.01-1.33); 早产儿从9.7到11.2% (RR 1.09; 95% CI 0.96-1.24)，主要包括早产新生儿; 从43.2到54.8% 的CS (RR 1.21; 95% CI 1.16-1.26)。孕妇年龄 ≥ 30岁是LBW、早产和CS的危险因素; LBW是CS的额外危险因素。然而，在研究期间，LBW和CSs增加，与产妇年龄无关。总之，在经济衰退期间，观察到围产期参数受损，表现为孕产妇年龄，LBW，早产和CS率的增加，可能对以后的健康产生不利影响。