背景:在围产期使用或正在接受药物治疗的妇女通常有复杂的需求并出现合并症。怀孕期间使用阿片类药物的女性,和他们的婴儿,经历糟糕的结果。妇女在怀孕期间使用药物是公共卫生的优先事项。这项范围审查旨在(1)绘制临床指南,英国各地针对围产期使用或正在接受药物治疗的女性的治疗方案和良好实践指导,(2)确定建议的卫生和社会护理最佳做法,以优化结果并减少这些妇女的不平等;(3)确定指导中的潜在差距。
方法:我们遵循了JoannaBriggsInternational(JBI)关于范围审查和PRISMAScr扩展的指导。注册的协议,包含明确的搜索策略,inclusion,并遵守排除标准.审稿人双重筛选了25%,讨论分歧。使用预定义的模板提取数据,并在表中绘制。围绕商定的类别组织了最佳实践建议。
结果:在筛选的968个文档中,111符合纳入标准。这些文件包括整个英国,国家,区域,和组织政策文件。它们与围产期使用药物或正在接受药物治疗的妇女相关的程度各不相同,他们应用的设置,和他们的目标用户。大多数是在没有患者或公众参与的情况下创建的,并且缺乏任何明确的证据基础。总的来说,文件推荐了与主要专业人员的综合护理模式,明确转诊途径和机构之间的信息共享。指导建议应将转介给专业助产士,药物,和社会关怀服务。全面评估,建议包括父亲/伴侣。最近的文件提倡采用创伤护理方法。在需要的情况下,建议在整个怀孕期间使用阿片类药物替代疗法(OST)。在产后为妇女提供支持方面发现了潜在的差距,尤其是当他们的孩子从他们的照顾。
结论:此推荐实践综合为从业人员提供了关键信息,服务提供商和政策制定者。它还强调了指南必须以证据为基础,根据围产期使用药物或正在接受药物治疗的妇女的经验,并解决将婴儿从护理中移出的产后妇女的支持需求。
BACKGROUND: Women who use or are in treatment for drug use during the perinatal period often have complex needs and presenting comorbidity. Women who use opioids during pregnancy, and their infants, experience poor outcomes. Drug use by women during pregnancy is a public health priority. This scoping review aimed to (1) map clinical
guidelines, treatment protocols and good practice
guidance across the UK for women who use or are in treatment for drug use during the perinatal period, (2) identify recommended best practice across health and social care for optimising outcomes and reducing inequalities for these women and (3) identify potential gaps within
guidance.
METHODS: We followed the Joanna Briggs International (JBI)
guidance on scoping reviews and PRISMA Scr extension. A registered protocol, containing a clear search strategy, inclusion, and exclusion criteria was adhered to. Reviewers double screened 25%, discussing disagreements. Data were extracted using a predefined template and charted in tables. Recommendations for best practice were organised around agreed categories.
RESULTS: Of 968 documents screened, 111 met the inclusion criteria. The documents included UK-wide, national, regional, and organisational policy documents. They varied in the degree they were relevant to women who use or are in treatment for drug use during the perinatal period, the settings to which they applied, and their intended users. Most were created without patient or public involvement and lacked any clear evidence base. Overall, documents recommended an integrated model of care with a lead professional, clear referral pathways and information sharing between agencies.
Guidance suggested referrals should be made to specialist midwives, drug, and social care services. A holistic assessment, inclusive of fathers / partners was suggested. Recent documents advocated a trauma-informed care approach. Opioid substitution therapy (OST) was recommended throughout pregnancy where required. Potential gaps were identified around provision of support for women postnatally, especially when their baby is removed from their care.
CONCLUSIONS: This synthesis of recommended practice provides key information for practitioners, service providers and policy makers. It also highlights the need for
guidelines to be evidence-based, informed by the experiences of women who use or are in treatment for drug use during the perinatal period, and to address the support needs of postnatal women who have their babies removed from their care.