Effectiveness of early warning assessment for risks and management during pregnancy on perinatal outcomes / 中华围产医学杂志

ABSTRACT

Objeetive To explore the effectiveness of early warning assessment and management for maternity on perinatal outcomes.Methods From January 1,2013,a cohort prospective study was conducted on 49 261 pregnant women who registered initially at 6-13 gestational weeks and were followed up at 246 community health centers from 17 districts or counties of Shanghai.The first screening was conducted in community health centers for gestational age verification,medical history collection and physical examination.The pregnant women would be marked as green alert if all of the above three indices were normal.A woman would be transferred to level two or above hospitals if the first screening results were abnormal and the early warning signs were divided into five categories,including green alert (normal),red alert (complicated with sever mobility and complications during pregnancy),orange alert (complicated with sever mobility and complications during pregnancy,but not as severe as that of red alert),purple alert (concomitant communicable diseases during pregnancy),yellow alert (complicated with milder mobility and complications during pregnancy compared with that of red alert).The low risk pregnancy referred to yellow alert,and the high risk ones referred to orange,red or purple alert.We offered corresponding management and follow-up program for women with different warning signs,and analyzed the in-process indices such as screening-transport time,transport-diagnosis time,diagnosis-feedback time,feedback-initial-follow-up time,times of follow-up and regular or irregular follow-up.The association between in-process indices and perinatal outcomes (women with severe diseases during pregnancy and delivery,maternal mortality,preterm and low birth weight children and neonatal mortality) in both low and high risk pregnant women were analyzed using logistic regression model.Results Out of the 49 261 pregnant women,10 485(21.28％) were positive in the first screening and 38 776 (78.72％) were negative.For early warning classification,36 250(73.59％) were classified as green alert,12 277(24.92％) as yellow alert,625(1.27％) as orange alert,8(0.02％) as red alert,and 101(0.21％) as purple alert.The regular follow-up rate for low risk pregnant women was 82.7％(10 153/12 277),and that of high risk women was 74.1％(544/734).Prolonged feedback-initial-follow-up time increased the risk of maternal mortality (OR=1.051,95％CI1.015-1.088,P=0.008) among low and high risk pregnant women.The increased times of follow-up for risk pregnancies decreased the occurrence of critical illed complications (OR=0.851,95％CI0.725-0.999,P=0.049) and maternal mortality (OR=0.534,95％CI0.307 0.930,P=0.014).Prolonged diagnosis-feedback time increased the risk of preterm birth (OR=l.009,95％CI1.004-1.015,P=0.000).Prolonged feedback-initial-follow-up time increased the risk of neonatal mortality (OR=1.019,95％CI1.001-1.038,P=0.045).However,the increase of followup times decreased the risk of preterm birth (OR=0.803,95％CI0.762-0.847,P＜0.001),low-birth weight (OR=0.882,95％ CI0.775-0.873,P＜0.001) and neonatal mortality (OR=0.653,95％CI0.543-0.785,P＜0.001),so did regular follow-up (OR=0.432,95％CI0.353-0.528;OR=0.494,95％CI0.392-0.621;OR=0.226,95％CI0.117-0.435;all P＜0.001).Conclusions The system of early warning assessment and management for pregnancy is effective on perinatal outcomes to some in both low and high risk gravidas extend and is worthwhile to be generalized and to form long-term mechanism.