PDF(Pubmed)
Abstract：
BACKGROUND: According to World Health Organization (WHO), the postnatal care provision aims to provide care and treatment with the highest quality and the least intervention to obtain the best health and well-being for the family. The present study aims to adapt international guidelines for the clinical recommendations for the postpartum period and implement and determine its effectiveness.
METHODS: This study will be done in two phases. In the first phase, international clinical guidelines for mother and newborn postnatal care will be adapted. The second phase is a randomized controlled trial in which the adapted guideline recommendations will be implemented, and maternal and neonatal outcomes will be measured. The ADAPTE method for adaptation of clinical guidelines, is usedg in the first phase. A systematic review was conducted in the databases and clinical guidelines related to postpartum care were extracted according to the inclusion criteria. The quality of clinical guidelines was evaluated using the AGREE-II tool. The WHO clinical guideline obtained the highest evaluation score and was chosen as the main guideline, and the NICE clinical guideline, with a second higher evaluation score, was also used to fill some gaps in the WHO guideline. Based on the pre-determined questions, recommendations will be sent to the relevant experts and stakeholders for their evaluation. After the external evaluation and the finalization of the recommendations, the postpartum clinical guideline will be compiled and used in the second phase of the study. In the second phase, 272 women in the immediate postnatal stage of the maternity and postpartum ward of Taleghani and AL-Zahra Hospitals in Tabriz will be assigned into the intervention (receiving care based on adapted guidline recommendations) and control (receiving routine hospital care) groups uing individual stratified block randomization. At 6 weeks after birth, we will complete the Edinburgh postnatal depression scale, postpartum specific anxiety scale and Barkin index of maternal functioning (to assess the primary outcomes), as well as a maternal health problems checklist, infant care behavior, and violence assessment questionnaires (to asses the seconadary outcomes). Further, the maternal health problems checklist and the Edinburgh postnatal depression scale will be completed in the second week after birth. The data will be analyzed using an independent t-test and ANCOVA.
CONCLUSIONS: It is expected that the implementation of evidence-based clinical guidelines improves maternal and neonatal outcomes and experience of the postpartum period. The positive experience can also help to achieve Iran\'s population policies and the need to increase childbearing in the country.
BACKGROUND: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N76; Date of registration: 27/1/2023. URL: https://en.irct.ir/user/trial/66874/view ; Date of first registration: 27/3/2023.
The postpartum period, starting immediately after childbirth up to the first six weeks (42 days), is a significant and critical period in the lives of mothers and newborns, spouses, caregivers, and families. Maternal and newborn deaths and complications are high during the postpartum period. Postpartum care with high quality could reduce maternal and newborn deaths and complications, and makes the mother have a positive childbirth experience and a favourable attitude toward her next birth. World Health Organization (WHO) recommend providing medical care and treatment with the highest quality and the least intervention to obtain the best health and well-being conditions for the family. The present study aims to localize and use the international recommendations for the postpartum period in Iran. This study will be done in two phases. In the first phase, the international recommendations for mother and newborn care and postnatal well-being will be adapted according to our country\'s resources and conditions. In the second phase, the recommendations of adapted guideline will be implemented on 272 mothers and newborn in two groups in the maternity and postpartum ward of Taleghani and AL-zahra Hospitals in Tabriz, and we compare the result of using these recommendations and routine care on mothers\' and newborns\' well-being. In clinical guideline recommendations group, we will educate mothers, fathers and families and will share with them adapted recommendations, up to 6 weeks after birth and we will support them via the network. During the postpartum period we will assess mental and physical health problems of the mothers; counsel about breastfeeding, baby care, family planning, nutrition, activity, pain killer, bonding and emotional attachment, and prevention of postpartum depression; and any questions will be answered.
METHODS: This study will be done in two phases. In the first phase, international clinical guidelines for mother and newborn postnatal care will be adapted. The second phase is a randomized controlled trial in which the adapted guideline recommendations will be implemented, and maternal and neonatal outcomes will be measured. The ADAPTE method for adaptation of clinical guidelines, is usedg in the first phase. A systematic review was conducted in the databases and clinical guidelines related to postpartum care were extracted according to the inclusion criteria. The quality of clinical guidelines was evaluated using the AGREE-II tool. The WHO clinical guideline obtained the highest evaluation score and was chosen as the main guideline, and the NICE clinical guideline, with a second higher evaluation score, was also used to fill some gaps in the WHO guideline. Based on the pre-determined questions, recommendations will be sent to the relevant experts and stakeholders for their evaluation. After the external evaluation and the finalization of the recommendations, the postpartum clinical guideline will be compiled and used in the second phase of the study. In the second phase, 272 women in the immediate postnatal stage of the maternity and postpartum ward of Taleghani and AL-Zahra Hospitals in Tabriz will be assigned into the intervention (receiving care based on adapted guidline recommendations) and control (receiving routine hospital care) groups uing individual stratified block randomization. At 6 weeks after birth, we will complete the Edinburgh postnatal depression scale, postpartum specific anxiety scale and Barkin index of maternal functioning (to assess the primary outcomes), as well as a maternal health problems checklist, infant care behavior, and violence assessment questionnaires (to asses the seconadary outcomes). Further, the maternal health problems checklist and the Edinburgh postnatal depression scale will be completed in the second week after birth. The data will be analyzed using an independent t-test and ANCOVA.
CONCLUSIONS: It is expected that the implementation of evidence-based clinical guidelines improves maternal and neonatal outcomes and experience of the postpartum period. The positive experience can also help to achieve Iran\'s population policies and the need to increase childbearing in the country.
BACKGROUND: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N76; Date of registration: 27/1/2023. URL: https://en.irct.ir/user/trial/66874/view ; Date of first registration: 27/3/2023.
The postpartum period, starting immediately after childbirth up to the first six weeks (42 days), is a significant and critical period in the lives of mothers and newborns, spouses, caregivers, and families. Maternal and newborn deaths and complications are high during the postpartum period. Postpartum care with high quality could reduce maternal and newborn deaths and complications, and makes the mother have a positive childbirth experience and a favourable attitude toward her next birth. World Health Organization (WHO) recommend providing medical care and treatment with the highest quality and the least intervention to obtain the best health and well-being conditions for the family. The present study aims to localize and use the international recommendations for the postpartum period in Iran. This study will be done in two phases. In the first phase, the international recommendations for mother and newborn care and postnatal well-being will be adapted according to our country\'s resources and conditions. In the second phase, the recommendations of adapted guideline will be implemented on 272 mothers and newborn in two groups in the maternity and postpartum ward of Taleghani and AL-zahra Hospitals in Tabriz, and we compare the result of using these recommendations and routine care on mothers\' and newborns\' well-being. In clinical guideline recommendations group, we will educate mothers, fathers and families and will share with them adapted recommendations, up to 6 weeks after birth and we will support them via the network. During the postpartum period we will assess mental and physical health problems of the mothers; counsel about breastfeeding, baby care, family planning, nutrition, activity, pain killer, bonding and emotional attachment, and prevention of postpartum depression; and any questions will be answered.
摘要：
背景：根据世界卫生组织（WHO），产后护理提供旨在提供最高质量和最少干预的护理和治疗，以获得家庭的最佳健康和福祉。本研究旨在调整产后临床建议的国际指南，并实施和确定其有效性。
方法：本研究分两个阶段进行。在第一阶段,母亲和新生儿产后护理的国际临床指南将得到调整。第二阶段是一项随机对照试验，其中将实施适应的指南建议，将测量孕产妇和新生儿的结局。适应临床指南的适应方法，在第一阶段使用。在数据库中进行系统评价，并根据纳入标准提取与产后护理相关的临床指南。使用AGREE-II工具评估临床指南的质量。WHO临床指南获得了最高的评价评分,被选为主要指南,和NICE临床指南，第二个更高的评价分数，也被用来填补世卫组织指南中的一些空白。根据预先确定的问题，建议将发送给相关专家和利益相关者进行评估。在外部评估和最终确定建议之后，产后临床指南将在研究的第二阶段编制和使用.在第二阶段,在大不里士的Taleghani和AL-Zahra医院的产妇和产后病房出生后即刻阶段的272名妇女将被分配到干预组（根据适应的指南建议接受护理）和对照组（接受常规医院护理），并进行个人分层区组随机化。出生后6周，我们将完成爱丁堡产后抑郁量表，产后特异性焦虑量表和产妇功能巴金指数（评估主要结局），以及一份产妇健康问题清单，婴儿护理行为，和暴力评估问卷(评估次要结果)。Further,产妇健康问题检查表和爱丁堡产后抑郁量表将在出生后第二周完成。将使用独立t检验和ANCOVA分析数据。
结论：预期循证临床指南的实施改善了产妇和新生儿的结局和产后体验。积极的经验也有助于实现伊朗的人口政策和增加该国生育的需要。
背景：伊朗临床试验注册（IRCT）：IRCT20120718010324N76；注册日期：2023年1月27日。URL：https://en。irct.ir/用户/试用版/66874/视图；首次注册日期：2023年3月27日。
产后，分娩后立即开始，直到前六周（42天），是母亲和新生儿生命中重要而关键的时期，配偶,看护者,和家庭。产后期间孕产妇和新生儿死亡和并发症很高。优质的产后护理可以减少孕产妇和新生儿的死亡和并发症，并使母亲有积极的分娩经历和对她的下一个出生的积极态度。世界卫生组织（世卫组织）建议提供最高质量和最少干预的医疗和治疗，以获得家庭的最佳健康和福祉条件。本研究旨在本地化和使用伊朗产后的国际建议。这项研究将分两个阶段进行。在第一阶段,国际上关于母亲和新生儿护理和产后福祉的建议将根据我国的资源和条件进行调整。在第二阶段,调整指南的建议将在大不里士的Taleghani和AL-zahra医院的产科病房和产后两组的272名母亲和新生儿中实施，我们比较了使用这些建议和常规护理对母亲和新生儿健康的结果。在临床指南推荐组中，我们将教育母亲，父亲和家庭，并将与他们分享适应的建议，出生后6周，我们将通过网络支持他们。在产后期间，我们将评估母亲的身心健康问题;关于母乳喂养的建议，婴儿护理,计划生育,营养,活动,止痛药,结合和情感依恋，和预防产后抑郁症;任何问题都会得到回答。
方法：本研究分两个阶段进行。在第一阶段,母亲和新生儿产后护理的国际临床指南将得到调整。第二阶段是一项随机对照试验，其中将实施适应的指南建议，将测量孕产妇和新生儿的结局。适应临床指南的适应方法，在第一阶段使用。在数据库中进行系统评价，并根据纳入标准提取与产后护理相关的临床指南。使用AGREE-II工具评估临床指南的质量。WHO临床指南获得了最高的评价评分,被选为主要指南,和NICE临床指南，第二个更高的评价分数，也被用来填补世卫组织指南中的一些空白。根据预先确定的问题，建议将发送给相关专家和利益相关者进行评估。在外部评估和最终确定建议之后，产后临床指南将在研究的第二阶段编制和使用.在第二阶段,在大不里士的Taleghani和AL-Zahra医院的产妇和产后病房出生后即刻阶段的272名妇女将被分配到干预组（根据适应的指南建议接受护理）和对照组（接受常规医院护理），并进行个人分层区组随机化。出生后6周，我们将完成爱丁堡产后抑郁量表，产后特异性焦虑量表和产妇功能巴金指数（评估主要结局），以及一份产妇健康问题清单，婴儿护理行为，和暴力评估问卷(评估次要结果)。Further,产妇健康问题检查表和爱丁堡产后抑郁量表将在出生后第二周完成。将使用独立t检验和ANCOVA分析数据。
结论：预期循证临床指南的实施改善了产妇和新生儿的结局和产后体验。积极的经验也有助于实现伊朗的人口政策和增加该国生育的需要。
背景：伊朗临床试验注册（IRCT）：IRCT20120718010324N76；注册日期：2023年1月27日。URL：https://en。irct.ir/用户/试用版/66874/视图；首次注册日期：2023年3月27日。
产后，分娩后立即开始，直到前六周（42天），是母亲和新生儿生命中重要而关键的时期，配偶,看护者,和家庭。产后期间孕产妇和新生儿死亡和并发症很高。优质的产后护理可以减少孕产妇和新生儿的死亡和并发症，并使母亲有积极的分娩经历和对她的下一个出生的积极态度。世界卫生组织（世卫组织）建议提供最高质量和最少干预的医疗和治疗，以获得家庭的最佳健康和福祉条件。本研究旨在本地化和使用伊朗产后的国际建议。这项研究将分两个阶段进行。在第一阶段,国际上关于母亲和新生儿护理和产后福祉的建议将根据我国的资源和条件进行调整。在第二阶段,调整指南的建议将在大不里士的Taleghani和AL-zahra医院的产科病房和产后两组的272名母亲和新生儿中实施，我们比较了使用这些建议和常规护理对母亲和新生儿健康的结果。在临床指南推荐组中，我们将教育母亲，父亲和家庭，并将与他们分享适应的建议，出生后6周，我们将通过网络支持他们。在产后期间，我们将评估母亲的身心健康问题;关于母乳喂养的建议，婴儿护理,计划生育,营养,活动,止痛药,结合和情感依恋，和预防产后抑郁症;任何问题都会得到回答。
