目的:全面了解助产士的角色及其在预防中遇到的挑战,正常阴道分娩后产后出血(PPH)的诊断和管理。
方法:我们根据系统评价的首选报告项目和范围评价的Meta分析(PRISMA-ScR)建议进行了范围评价。
方法:我们考虑了与助产士的角色以及他们在预防中遇到的挑战有关的研究,阴道分娩过程中PPH的诊断和管理。我们排除了指南,共识,会议和非英语语言研究的摘要。数据库,包括Cochrane图书馆,PubMed,WebofScience,奥维德,Medline,Embase,JBIEBP和BIOSIS预览,于2023年1月1日进行了搜索,没有时间限制。
结果:我们纳入了28篇出版物。助产士在预防中发挥着重要作用,阴道分娩产后出血的诊断和处理。在预防PPH时,助产士的角色包括识别和管理高风险因素,管理劳动和实施皮肤与皮肤的接触。在PPH的诊断中,助产士的角色包括早期识别和失血估计。在PPH的管理中,助产士参与动员其他专业团队成员,应急管理,调查原因,增强子宫收缩,会阴眼泪的修复,安排转移和准备手术干预。然而,助产士面临巨大挑战,包括知识和技能不足,团队合作能力差,资源不足,需要处理他们的负面情绪。助产士必须提高他们的知识,技能和团队合作能力。卫生保健系统管理者和政府应全力支持助产士。未来的研究应该集中在为助产士制定临床实践指南,诊断和管理产后出血。
OBJECTIVE: To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery.
METHODS: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) recommendations.
METHODS: We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non-English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations.
RESULTS: We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives\' roles include identifying and managing high-risk factors, managing labour and implementing skin-to-skin contact. In the diagnosis of PPH, midwives\' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.