CAJ | 학술논문

目的：对上海市医疗机构妊娠风险预警评估管理的效果进行评价，为改进优化措施提供可靠的依据。方法在上海市17个区（县）各抽查1家助产医疗机构，获取其中预产期在4～6月并已随访管理结案的重点孕妇共3420名，分析妊娠风险评估管理模式对妊娠结局的影响。结果妊娠风险预警评估率达97．5％，黄色、橙色、紫色预警标示的孕产妇规范随访比例分别为62．8％、79．7％和44．4％，在控制了孕妇年龄、户籍、妊娠风险预警分类、分娩方式等混杂因素后，助产医疗机构对重点孕妇的随访次数增加（OR＝0．594，P＜0．05）和进行规范随访（OR＝0．268，P＜0．05），可降低早产的发生风险。结论上海市妊娠风险预警评估管理工作对于提高母婴安全具有一定效果，但助产医疗机构对于重点孕妇的随访管理仍有不足。
목적：대상해시의료궤구임신풍험예경평고관리적효과진행평개，위개진우화조시제공가고적의거。방법재상해시17개구（현）각추사1가조산의료궤구，획취기중예산기재4～6월병이수방관리결안적중점잉부공3420명，분석임신풍험평고관리모식대임신결국적영향。결과임신풍험예경평고솔체97．5％，황색、등색、자색예경표시적잉산부규범수방비례분별위62．8％、79．7％화44．4％，재공제료잉부년령、호적、임신풍험예경분류、분면방식등혼잡인소후，조산의료궤구대중점잉부적수방차수증가（OR＝0．594，P＜0．05）화진행규범수방（OR＝0．268，P＜0．05），가강저조산적발생풍험。결론상해시임신풍험예경평고관리공작대우제고모영안전구유일정효과，단조산의료궤구대우중점잉부적수방관리잉유불족。
Objective To evaluate the effect of risk assessment and management for pregnancy in obstetric medical institutions in Shanghai so as to provide evidences for improvement .Methods 17 obstetric medical institutions were selected from 17 districts in Shanghai .A total of 3 420 pregnant women who had established health care follow-up for pregnancy and who expected delivery date at the period of April to June were included in the study .The influence of the risk assessment and management for pregnancy on pregnancy outcomes was analyzed . Results The rate of risk assessment for pregnancy was 97.5%.The regular follow-up proportion of pregnant women with yellow , orange and purple sign was 62.8%, 79.7% and 44.4%, respectively.After controlling the factors of age , residence, pregnant risk category and delivery mode, the increase of follow-up frequency for high-risk pregnant women (OR=0.594, P<0.05) and regular follow-up (OR=0.268, P<0.05) could reduce the risks of preterm .Conclusion The risk assessment and management for pregnant women is effective in promoting maternal and infant safety .However , the management on follow-up for key pregnant women with risk of complications is insufficient in medical institutions .