社区孕产妇基本保健适宜技术研究
|
摘要
目的
孕产妇保健技术和方法众多,如何遴选出“安全、成熟、价廉、易操作、参与度高且效果明显的”孕产妇保健技术是本研究关注的重点。因此,在全面系统了解国内、外孕产妇保健现状和现有技术的基础上,遵循卫生技术评估和循证医学的原理,遴选出孕产妇保健适宜技术；结合国内社区的特点,通过孕产妇保健社区适宜技术筛选评估指标体系,遴选并论证出孕产妇保健社区适宜技术；提出被我国社区普遍接受的孕产妇孕前、产前、产时和产后等各期保健间隔周期、保健内容和保健路径,是本研究的目的。
方法
本研究力图对个体、技术、操作三个维度进行整合,以全流程、系统性和操作性作为总体研究思路,以结构-过程-结果模型、卫生技术评估、循证医学、项目管理及业务流程管理思路作为指导性研究方法,以文献计量分析、专家咨询、定性定量多重论证、焦点组访谈、现场调查、综合评价法为具体的研究的方法,实现孕产妇保健技术到孕产妇保健适宜技术,再到孕产妇保健社区适宜技术的遴选和论证。资料主要来自国内外文献资料和现场资料,现场资料包括北京、常州、嘉定三地的妇幼保健院及下属16个社区卫生服务中心的现场调查和专家论证。
结果
(一)国内外孕产妇保健现状的研究
本研究第一部分主要是系统了解国内外孕产妇保健现状和技术使用情况。因此,通过对24本国内保健手册、56篇国内文献、48项国内法规政策和10本国外保健指南的国内外文献的系统评阅和来自北京、常州和嘉定三家妇幼保健院及下属16个社区卫生服务中心的40名专家和40位孕产妇的访谈的现场资料的收集,系统、全面地了解了目前国内外孕产妇保健的现状和技术使用情况。孕前保健在框架、评价方法、保健流程及实施形式上已基本完善,但国内尚未系统开展孕前保健服务；产前保健在政策支持和开展模式方面均具有一定的系统性和规范性,但国外已经形成了基于社区的孕产妇保健模式,而国内针对社区的孕产妇保健研究甚少；产时保健以住院分娩为主；产后保健基本上建立了基于社区的产后家庭访视模式。在技术方面,孕产妇保健技术和方法众多,其中,孕前保健主要包括六大类技术,67个条目；产前保健主要包括七大类技术,107个条目；产时保健主要包括四大类技术,24个条目；产后保健针对产妇的包括七大类技术,22个条目,对新生儿的包括四三大类技术,16个条目。
(二)孕产妇保健适宜技术的遴选与论证
在系统了解孕产妇保健现状和技术使用情况的基础上,本研究第二部分是从众多孕产妇保健技术中遴选出适宜的孕产妇保健技术。因此,本研究根据卫生技术评估和循证医学的原理和方法,对孕产妇保健技术的适宜性进行了文献遴选和现场论证,文献主要包括20篇国内期刊文献、186篇国外期刊文献和5本国外保健指南,现场论证包括北京、常州和嘉定三个保健院及下属16个社区卫生服务中心和30名专家。结果表明,孕前保健具有较好的效益和效果,孕前保健包括风险评估、孕前咨询与健康促进、知情选择与医学干预,但涉及的大部分技术均来自专家建议,缺乏系统的文献评价。产前保健也具有较好的效益和效果,产前保健包括信息采集、体格检查、产科检查、实验室检查、健康档案管理、转诊评估和健康教育与促进,涉及的大部分技术均有系统的文献评价,评价显示,部分广泛应用于临床的保健技术的效果是缺乏证据支持的。产时保健中,与分娩相关的大部分技术均有系统的文献评价,并根据技术的适宜性分为有益的技术、常用但不适宜的技术、需要进一步明确的技术和应该废除的技术四大类。产后保健具有较好的成本效果,产后保健包括针对产妇和新生儿的健康评估和健康教育与促进,产后保健服务并不涉及复杂的技术。经过文献遴选和现场论证,孕产妇保健技术中,除了已经被普遍接受的适宜技术(如采集病史、体格检查、健康教育)外,孕产妇保健方面共有27项适宜技术,其中11项技术为产时适宜技术。
(三)构建孕产妇保健社区适宜技术筛选评估指标体系
在明确了孕产妇保健适宜技术的基础上,为了进一步遴选出孕产妇保健社区适宜技术,本研究第三部分构建了孕产妇保健社区适宜技术筛选评估指标体系。课题组通过对417篇国内期刊文献研究和专家咨询,结合国内社区的特点,拟定了孕产妇保健社区适宜技术筛选评估指标体系的基本框架。通过对来自北京、常州和嘉定16个社区卫生服务中心的30名专家进行的两轮Delphi咨询,构建了由6个一级指标、16个二级指标和24个三级指标组成的孕产妇保健社区适宜技术筛选评估指标体系,并确定了各级指标的权重。六个一级指标的权重分别为安全性0.2710、经济性0.1737、有效性0.1796、成熟性0.1397、可操作性0.1333、参与度0.1027。
(四)孕产妇保健社区适宜技术的遴选与评估
本研究第四部分主要是借助指标体系实现孕产妇保健适宜技术到孕产妇保健社区适宜技术的遴选,并进一步明确所遴选出的社区适宜技术在社区机构的可操作性。因此,课题组根据构建的孕产妇保健社区适宜技术筛选评估指标体系,通过国内外文献研究及来自北京、常州、嘉定妇保院的下属16个社区机构的30名专家及40名孕产妇的现场调查,按照指标体系的评分标准和筛选流程,对课题组前期遴选出的16项孕产妇保健适宜技术进行了社区适宜性评估,按照指标体系进行评分,≥7分为社区适宜的原则,遴选并论证出了10项适宜于我国社区的孕产妇保健适宜技术。
然后,通过基线调查及研究的阶段性评估,对课题组遴选出的社区适宜技术在社区机构的操作性及认可度进行了评估,评估显示,孕产妇保健社区适宜技术在社区内具有较好的可操作性,但社区发展不平衡,部分社区机构的孕产妇保健服务日趋萎缩,部分社区机构不适宜技术过度使用。同时,对我国社区开展孕产妇保健的频次、时机和内容进行了评价,为构建我国社区孕产妇保健模式提供了政策依据。
结论
亟需建立基于社区的孕产妇全流程保健模式,促进公共卫生服务均等化。亟需从政策、供方、需方促进孕前保健服务的系统开展,并逐步过渡到基于社区的孕前保健模式；政府需要制定政策引导和增加资源支持,促进我国社区孕产妇保健模式的建立,根据经济水平和社区服务提供能力,制定频次适宜的产前保健服务包,并制定相应的技术和管理规范,促进社区对孕产妇保健适宜技术的使用,避免非适宜技术的过度使用；加强产时保健适宜技术的使用；进一步强化基于社区的产后保健模式,促进产妇和新生儿的健康。
Objectives
How to select the'safe, mature, cheap, easy-manipulated, high-involved and effective’maternal health care technologies is the major focus of this study. Objectives of this study are:(1) to systematically review current available international and national literatures, documents, guidelines, and policies on technologies available to maternal health care; (2) to select appropriate technologies applied in maternal health care based on concepts and principles of health technology of assessment and evidence-based medicine; (3) to apply and evaluate appropriate technologies available to maternal health care in community through an assessment model of appropriate maternal health technologies for use in community; and (4) to propose and recommend appropriate frequency, timing, pathway and contents of heath care from preconception, antenatal, intrapartum to postpartum.
Methods
A comprehensive dataset was collected from literature review and field studies, and data was analyzed in individualized, technological and operational dimensions. The concept of whole process, system, and operating was applied as a framework for this study. Guided by principles of structure-process-outcome model, health technology assessment, evidence-based medicine, program administration, and work process administration, literature quantitative analysis, individual interview, group interview, qualitative and quantitative multiple demonstration, field study and comprehensive evaluation approaches were integrated in this study. Three maternal & child health care institutions in Beijing, Changzhou, and Jiaiding and 16 community health care service centers were chosen as our study fields.
Outcomes
1. Study on status quo of international and national maternal health care
The aim of first part of this study was to understand international and national technologies available to maternal health care. Based on a comprehensive review of literature of 24 national health care manuals,56 Chinese journal papers,48 items of national laws and regulations and 10 international health care guidelines, and the indepth interview of 40 experts and 40 pregnant women from three maternal & child health care institutions including Beijing, Changzhou, and Jiaiding and 16 community health service centers, the status quo and technologies in use have been clarified. The preconception care system was improved with the support of policy from four sides including the framework, risk-screening tool, service process and carrying pattern. The preconception care hasn't been systematic carried out due to lacking policy and inadequate demand. The antenatal care has been systematic and normative carried out for many years with the support of policy. But a model based community of maternal health care has been formed abroad and has still been less studied internal. Childbirth in hospital has been advocated both abroad and home. And a pattern based community of family visiting postpartum has been established. As technologies as concerned, there were so many technologies available to maternal health care,6 categories including 67 items were used in preconception care,7 categories including 107 items were used in antenatal care,4 categories including 24 items were used in intrapartum care,7 categories including 22 items for mother and 4 categories including 16 items for baby were used in postpartum care.
2. Selection and assessment of appropriate technologies from all technologies available to maternal health care
The second part of this study aimed to select appropriate technologies from all technologies available maternal health care. So, following the concepts and methods of health technology assessment and evidenced based medicine, appropriate technologies were picked up based on literatures including 20 pieces of Chinese journal papers,186 pieces of international journal papers and 5 pieces international health care guidelines and field studies including investigation and interview to three maternal & child health care institutions including Beijing, Changzhou, and Jiaiding and 16 community health service centers and 30 experts. The outcome showed that preconception care was a cost-effective and cost-benefit program, which includes risking assessment, consultation and health promotion, informed choice and medical intervention. But most technologies available to preconception care were from advices of expert panel. The antenatal care was also a cost-effective and cost-benefit program, which includes information collecting, physical examination, obstetrical examination, lad test, file administration, risk screening and health education. The most technologies available to prenatal care have been evaluated by systematic reviews, which indicated many technologies applied in clinical care widely had no support of evidences. Technologies related to delivery were classified four, including benefit technology, in common use but not appropriate technology, unclear technology and be abolished technology. Postpartum care was also a cost-effective and cost-benefit program without intricate technologies, which including health assessment and health education for mother and baby. Besides the universal appropriate technologies (such as collecting history, physical examination and health education),27 items were chosen from technologies available to maternal health care, and 11 articles related to childbirth were involved.
3. Establishment of an assessment model of appropriate maternal health technologies for use in community
The third part of this study aimed to establish an assessment model of appropriate maternal health technologies for use in community. Through literature study of 417 pieces of journal papers and expert consultation combined with the characteristic of domestic community, a framework of the assessment model of appropriate maternal health technologies for use in community was mapped out. Then an assessment model of appropriate maternal health technologies for use in community consisting of 6 first-level indicators,16 second-level indicators and 24 third-level indicators was established through the method of Delphi involving 30 experts from 16 community service centers of Beijing, Changzhou and Jiading. Weights for each indicator were also determined, and the weights of six first-level indicators are following:safety is 0.2710, economic attribute is 0.1737, validity is 0.1796, maturity is 0.1397, convenience is 0.1333, participation is 0.1027.
4. Selection and evaluation of appropriate technologies of maternal health care in community
The Forth part of this study aimed to choose and evaluate appropriate technologies of maternal health care in community through the assessment model of appropriate maternal health technologies for use in community and to verify the feasibility of applying appropriate technologies into community. So, with the help of the assessment model, according to the grade standard and screening method, with the principle of appropriateness more than 7 score,10 items have been selected from 16 articles of appropriate technologies through literature study and field study which includes 30 experts and 40 pregnant women from 16 community service centers of Beijing, Changzhou and Jiading.
Then, the feasibility and acceptance of appropriate technologies selected through the assessment model have been evaluated by baseline investigation and staged appraisal. The outcomes showed that the appropriate technologies picked up by the assessment model could be well complemented in communities and the development of maternal health care in community was unbalanced. Maternal health care services withered due to lack of resources and the demand in some communities. However, many inappropriate technologies have been excessively supplied to pregnant women in other communities. And then the appropriate frequency, timing, paths and contents of stages heath care from preconception, antenatal, intrapartum to postpartum were suggested.
Conclusions
It is strongly recommended that the promotion of preconception care should be stressed from policy, the supply and the demand level, and community-based preconception care model should be established step by step. The model of community-based perinatal health care should be built with the policy guiding and resource support from government. Community health care center should provide mother and baby package with appropriate frequency according to local economic level and the capacity of supplying. Moreover, technological and administrating norm should be formed to encourage the application of appropriate technologies and avoiding inappropriate technologies. It is also recommended to apply appropriate childbirth technologies, and strengthen community-based postpartum care, so as to improve mother and baby's health.
孕产妇保健技术和方法众多,如何遴选出“安全、成熟、价廉、易操作、参与度高且效果明显的”孕产妇保健技术是本研究关注的重点。因此,在全面系统了解国内、外孕产妇保健现状和现有技术的基础上,遵循卫生技术评估和循证医学的原理,遴选出孕产妇保健适宜技术；结合国内社区的特点,通过孕产妇保健社区适宜技术筛选评估指标体系,遴选并论证出孕产妇保健社区适宜技术；提出被我国社区普遍接受的孕产妇孕前、产前、产时和产后等各期保健间隔周期、保健内容和保健路径,是本研究的目的。
方法
本研究力图对个体、技术、操作三个维度进行整合,以全流程、系统性和操作性作为总体研究思路,以结构-过程-结果模型、卫生技术评估、循证医学、项目管理及业务流程管理思路作为指导性研究方法,以文献计量分析、专家咨询、定性定量多重论证、焦点组访谈、现场调查、综合评价法为具体的研究的方法,实现孕产妇保健技术到孕产妇保健适宜技术,再到孕产妇保健社区适宜技术的遴选和论证。资料主要来自国内外文献资料和现场资料,现场资料包括北京、常州、嘉定三地的妇幼保健院及下属16个社区卫生服务中心的现场调查和专家论证。
结果
(一)国内外孕产妇保健现状的研究
本研究第一部分主要是系统了解国内外孕产妇保健现状和技术使用情况。因此,通过对24本国内保健手册、56篇国内文献、48项国内法规政策和10本国外保健指南的国内外文献的系统评阅和来自北京、常州和嘉定三家妇幼保健院及下属16个社区卫生服务中心的40名专家和40位孕产妇的访谈的现场资料的收集,系统、全面地了解了目前国内外孕产妇保健的现状和技术使用情况。孕前保健在框架、评价方法、保健流程及实施形式上已基本完善,但国内尚未系统开展孕前保健服务；产前保健在政策支持和开展模式方面均具有一定的系统性和规范性,但国外已经形成了基于社区的孕产妇保健模式,而国内针对社区的孕产妇保健研究甚少；产时保健以住院分娩为主；产后保健基本上建立了基于社区的产后家庭访视模式。在技术方面,孕产妇保健技术和方法众多,其中,孕前保健主要包括六大类技术,67个条目；产前保健主要包括七大类技术,107个条目；产时保健主要包括四大类技术,24个条目；产后保健针对产妇的包括七大类技术,22个条目,对新生儿的包括四三大类技术,16个条目。
(二)孕产妇保健适宜技术的遴选与论证
在系统了解孕产妇保健现状和技术使用情况的基础上,本研究第二部分是从众多孕产妇保健技术中遴选出适宜的孕产妇保健技术。因此,本研究根据卫生技术评估和循证医学的原理和方法,对孕产妇保健技术的适宜性进行了文献遴选和现场论证,文献主要包括20篇国内期刊文献、186篇国外期刊文献和5本国外保健指南,现场论证包括北京、常州和嘉定三个保健院及下属16个社区卫生服务中心和30名专家。结果表明,孕前保健具有较好的效益和效果,孕前保健包括风险评估、孕前咨询与健康促进、知情选择与医学干预,但涉及的大部分技术均来自专家建议,缺乏系统的文献评价。产前保健也具有较好的效益和效果,产前保健包括信息采集、体格检查、产科检查、实验室检查、健康档案管理、转诊评估和健康教育与促进,涉及的大部分技术均有系统的文献评价,评价显示,部分广泛应用于临床的保健技术的效果是缺乏证据支持的。产时保健中,与分娩相关的大部分技术均有系统的文献评价,并根据技术的适宜性分为有益的技术、常用但不适宜的技术、需要进一步明确的技术和应该废除的技术四大类。产后保健具有较好的成本效果,产后保健包括针对产妇和新生儿的健康评估和健康教育与促进,产后保健服务并不涉及复杂的技术。经过文献遴选和现场论证,孕产妇保健技术中,除了已经被普遍接受的适宜技术(如采集病史、体格检查、健康教育)外,孕产妇保健方面共有27项适宜技术,其中11项技术为产时适宜技术。
(三)构建孕产妇保健社区适宜技术筛选评估指标体系
在明确了孕产妇保健适宜技术的基础上,为了进一步遴选出孕产妇保健社区适宜技术,本研究第三部分构建了孕产妇保健社区适宜技术筛选评估指标体系。课题组通过对417篇国内期刊文献研究和专家咨询,结合国内社区的特点,拟定了孕产妇保健社区适宜技术筛选评估指标体系的基本框架。通过对来自北京、常州和嘉定16个社区卫生服务中心的30名专家进行的两轮Delphi咨询,构建了由6个一级指标、16个二级指标和24个三级指标组成的孕产妇保健社区适宜技术筛选评估指标体系,并确定了各级指标的权重。六个一级指标的权重分别为安全性0.2710、经济性0.1737、有效性0.1796、成熟性0.1397、可操作性0.1333、参与度0.1027。
(四)孕产妇保健社区适宜技术的遴选与评估
本研究第四部分主要是借助指标体系实现孕产妇保健适宜技术到孕产妇保健社区适宜技术的遴选,并进一步明确所遴选出的社区适宜技术在社区机构的可操作性。因此,课题组根据构建的孕产妇保健社区适宜技术筛选评估指标体系,通过国内外文献研究及来自北京、常州、嘉定妇保院的下属16个社区机构的30名专家及40名孕产妇的现场调查,按照指标体系的评分标准和筛选流程,对课题组前期遴选出的16项孕产妇保健适宜技术进行了社区适宜性评估,按照指标体系进行评分,≥7分为社区适宜的原则,遴选并论证出了10项适宜于我国社区的孕产妇保健适宜技术。
然后,通过基线调查及研究的阶段性评估,对课题组遴选出的社区适宜技术在社区机构的操作性及认可度进行了评估,评估显示,孕产妇保健社区适宜技术在社区内具有较好的可操作性,但社区发展不平衡,部分社区机构的孕产妇保健服务日趋萎缩,部分社区机构不适宜技术过度使用。同时,对我国社区开展孕产妇保健的频次、时机和内容进行了评价,为构建我国社区孕产妇保健模式提供了政策依据。
结论
亟需建立基于社区的孕产妇全流程保健模式,促进公共卫生服务均等化。亟需从政策、供方、需方促进孕前保健服务的系统开展,并逐步过渡到基于社区的孕前保健模式；政府需要制定政策引导和增加资源支持,促进我国社区孕产妇保健模式的建立,根据经济水平和社区服务提供能力,制定频次适宜的产前保健服务包,并制定相应的技术和管理规范,促进社区对孕产妇保健适宜技术的使用,避免非适宜技术的过度使用；加强产时保健适宜技术的使用；进一步强化基于社区的产后保健模式,促进产妇和新生儿的健康。
Objectives
How to select the'safe, mature, cheap, easy-manipulated, high-involved and effective’maternal health care technologies is the major focus of this study. Objectives of this study are:(1) to systematically review current available international and national literatures, documents, guidelines, and policies on technologies available to maternal health care; (2) to select appropriate technologies applied in maternal health care based on concepts and principles of health technology of assessment and evidence-based medicine; (3) to apply and evaluate appropriate technologies available to maternal health care in community through an assessment model of appropriate maternal health technologies for use in community; and (4) to propose and recommend appropriate frequency, timing, pathway and contents of heath care from preconception, antenatal, intrapartum to postpartum.
Methods
A comprehensive dataset was collected from literature review and field studies, and data was analyzed in individualized, technological and operational dimensions. The concept of whole process, system, and operating was applied as a framework for this study. Guided by principles of structure-process-outcome model, health technology assessment, evidence-based medicine, program administration, and work process administration, literature quantitative analysis, individual interview, group interview, qualitative and quantitative multiple demonstration, field study and comprehensive evaluation approaches were integrated in this study. Three maternal & child health care institutions in Beijing, Changzhou, and Jiaiding and 16 community health care service centers were chosen as our study fields.
Outcomes
1. Study on status quo of international and national maternal health care
The aim of first part of this study was to understand international and national technologies available to maternal health care. Based on a comprehensive review of literature of 24 national health care manuals,56 Chinese journal papers,48 items of national laws and regulations and 10 international health care guidelines, and the indepth interview of 40 experts and 40 pregnant women from three maternal & child health care institutions including Beijing, Changzhou, and Jiaiding and 16 community health service centers, the status quo and technologies in use have been clarified. The preconception care system was improved with the support of policy from four sides including the framework, risk-screening tool, service process and carrying pattern. The preconception care hasn't been systematic carried out due to lacking policy and inadequate demand. The antenatal care has been systematic and normative carried out for many years with the support of policy. But a model based community of maternal health care has been formed abroad and has still been less studied internal. Childbirth in hospital has been advocated both abroad and home. And a pattern based community of family visiting postpartum has been established. As technologies as concerned, there were so many technologies available to maternal health care,6 categories including 67 items were used in preconception care,7 categories including 107 items were used in antenatal care,4 categories including 24 items were used in intrapartum care,7 categories including 22 items for mother and 4 categories including 16 items for baby were used in postpartum care.
2. Selection and assessment of appropriate technologies from all technologies available to maternal health care
The second part of this study aimed to select appropriate technologies from all technologies available maternal health care. So, following the concepts and methods of health technology assessment and evidenced based medicine, appropriate technologies were picked up based on literatures including 20 pieces of Chinese journal papers,186 pieces of international journal papers and 5 pieces international health care guidelines and field studies including investigation and interview to three maternal & child health care institutions including Beijing, Changzhou, and Jiaiding and 16 community health service centers and 30 experts. The outcome showed that preconception care was a cost-effective and cost-benefit program, which includes risking assessment, consultation and health promotion, informed choice and medical intervention. But most technologies available to preconception care were from advices of expert panel. The antenatal care was also a cost-effective and cost-benefit program, which includes information collecting, physical examination, obstetrical examination, lad test, file administration, risk screening and health education. The most technologies available to prenatal care have been evaluated by systematic reviews, which indicated many technologies applied in clinical care widely had no support of evidences. Technologies related to delivery were classified four, including benefit technology, in common use but not appropriate technology, unclear technology and be abolished technology. Postpartum care was also a cost-effective and cost-benefit program without intricate technologies, which including health assessment and health education for mother and baby. Besides the universal appropriate technologies (such as collecting history, physical examination and health education),27 items were chosen from technologies available to maternal health care, and 11 articles related to childbirth were involved.
3. Establishment of an assessment model of appropriate maternal health technologies for use in community
The third part of this study aimed to establish an assessment model of appropriate maternal health technologies for use in community. Through literature study of 417 pieces of journal papers and expert consultation combined with the characteristic of domestic community, a framework of the assessment model of appropriate maternal health technologies for use in community was mapped out. Then an assessment model of appropriate maternal health technologies for use in community consisting of 6 first-level indicators,16 second-level indicators and 24 third-level indicators was established through the method of Delphi involving 30 experts from 16 community service centers of Beijing, Changzhou and Jiading. Weights for each indicator were also determined, and the weights of six first-level indicators are following:safety is 0.2710, economic attribute is 0.1737, validity is 0.1796, maturity is 0.1397, convenience is 0.1333, participation is 0.1027.
4. Selection and evaluation of appropriate technologies of maternal health care in community
The Forth part of this study aimed to choose and evaluate appropriate technologies of maternal health care in community through the assessment model of appropriate maternal health technologies for use in community and to verify the feasibility of applying appropriate technologies into community. So, with the help of the assessment model, according to the grade standard and screening method, with the principle of appropriateness more than 7 score,10 items have been selected from 16 articles of appropriate technologies through literature study and field study which includes 30 experts and 40 pregnant women from 16 community service centers of Beijing, Changzhou and Jiading.
Then, the feasibility and acceptance of appropriate technologies selected through the assessment model have been evaluated by baseline investigation and staged appraisal. The outcomes showed that the appropriate technologies picked up by the assessment model could be well complemented in communities and the development of maternal health care in community was unbalanced. Maternal health care services withered due to lack of resources and the demand in some communities. However, many inappropriate technologies have been excessively supplied to pregnant women in other communities. And then the appropriate frequency, timing, paths and contents of stages heath care from preconception, antenatal, intrapartum to postpartum were suggested.
Conclusions
It is strongly recommended that the promotion of preconception care should be stressed from policy, the supply and the demand level, and community-based preconception care model should be established step by step. The model of community-based perinatal health care should be built with the policy guiding and resource support from government. Community health care center should provide mother and baby package with appropriate frequency according to local economic level and the capacity of supplying. Moreover, technological and administrating norm should be formed to encourage the application of appropriate technologies and avoiding inappropriate technologies. It is also recommended to apply appropriate childbirth technologies, and strengthen community-based postpartum care, so as to improve mother and baby's health.
引文
[1]国务院.母婴安全是社会发展水平标志[R].中国妇女发展纲要(2001—2010),2001].
[2]World health organization (WHO). Mother and baby package:Implementing Safe Motherhood in countries[R]. (WHO/FHE/MSM/94.11 Rev.1) Geneva,1996.
[3]全国孕产妇死亡监测协作组.全国孕产妇死亡监测结果分析[J].中华妇产科杂志,1999,34(11)：645-648.
[4]徐香芬.永康市2002-2004年高危孕产妇监测情况分析[J].中国妇幼保健.2006,(21)：184-185
[5]高惠琦,乔磊,黄敬亨.世界卫生组织人人享有卫生保健战略的由来和发展[J].中国初级卫生保健,2004,18(8)：3-5.
[6]Carroll G, Villar J, Piaggio G, et al. WHO systematic review of randomised controlled trials of routine antenatal care [J]. Lancet,2001,357 (9628):1565-1570.
[7]联合国儿童基金会中国办事处.[EB/OL]. http://www.unicef.org/china/zh/health. html.
[8]方利文,楼超华,高尔生.中国已婚育龄妇女产前保健服务研究[J].中国妇幼保健,2005,20(12)：1424-1426.
[9]叶文芸.重度高危孕产妇810例分析及护理对策[J].解放军护理杂志.2006,23(9)：55-56
[10]陈洁主编.医学技术评估[M].上海医科大学出版社,1996年8月第1版.
[11]冯皓.医疗保健技术评估的理论与方法[J].国外医学·医院管理分册,1994,(1)：1-7.
[1]郭鑫,邓丽娜.归纳演绎在管理学中的应用[J.]合作经济与科技,2006,(7)：22-23.
[2]郑文晖.文献计量法与内容分析法的比较研究[J].情报杂志,2006,(5)：31-33.
[3]邹菲.内容分析法的理论与实践研究[J].评价与管理,2006,(4)：71-77.
[4]郑文晖.文献计量法与内容分析法的比较研究[J].情报杂志,2006,(5)：31-33.
[5]陈英耀主编.卫生服务评价[M].复旦大学出版社,2007,3.
[1]World health organization (WHO). Mother and baby package:Implementing Safe Motherhood in countries[R]. (WHO/FHE/MSM/94.11 Rev.1) Geneva,1996.
[2]卫生部,孕前保健服务工作规范(试行),2007.
[3]上海市卫生局,上海市孕产期系统保健工作规范,2002.
[4]National Collaborating Centre for Womens's and Children's Health, Antenatal Care-routine care for the healthy pregnant woman, ISBN 1900364 913,2003.10
[5]University of Michigan Health System, Guidelines for Clinical Care-Prenatal Care, UMHS Prenatal Care Guideline,2006.6
[6]卫生部.全国城市围产保健管理办法.http://wsi.sh.gov.cn.
[7]World health organization (WHO). Antenatal care randomized trial Manual for the Implementation of the New Model[R].2002.
[8]卫生部.农村孕产妇系统保健管理办法(试行),1989.
[9]广东省助产技术服务基本条件.广东省卫生局.粤卫(2003)47号.
[10]周虹,钟玲,刘建等.社会因素剖宫产及剖宫产率的临床评价[J].实用妇产科杂志,2007,23(10)：736-737.
[11]华嘉增.产时保健的新模式[J].中国实用妇科与产科杂,2001,(5)：263-264.
[12]World health organization (WHO). Pregnancy, Childbirth, Postpartum and Newborn Care:A guide for essential practice[R]. ISBN 92 4 159084 X (NLM classification: WQ 175),2006.2nd edtion.
[13]郑晓瑛,陈嵘,张蕾.孕前-围孕保健的ACI模式[J].中国计划生育学杂志,2006,11(133)：652-655.
[14]University of Michigan Health System. Guidelines for Clinical Care-Prenatal Care. UMHS Prenatal Care Guideline,2006,6.
[15]Preconception care is crucial to improving maternal and infant health[R]. Medical letter on the CDC & FDA. Atlanta: Oct 22,2006:86.
[16]Alexander D. Allaire & Robert C. Cefalo. Preconceptional health care model[J]. European journal of Obstetrics & Gynecology and reproductive biology,1998,78(2): 163-168.
[17]Reynolds H.D. Preconception care:An integral part of primary care for women[J]. Journal of nurse-midwifery,1998,43(6):445-458.
[18]Lynnl S, Barbaras A. Preconceptual obstetric risk assessment and health promotion[J]. American Family Physician,1995,51:1878.
[19]Lu, Michael C. Recommendations for Preconception Care[J]. American Family Physician,2007,76(3):397-400.
[20]Atrash, Hani; Jack, Brian W; Johnson, Kay. Preconception care:a 2008 update[J]. Current opinion in Obstetrics & Gynecology,2008,20(6):581-589.
[21]Moos MK. Preconceptional health promotion: A health education opportunity for all women[J]. Women Health,1989,15:55-68.
[22]Connie Schrander-Stumpel. Preconception Care:Challenge of the New Millennium?[J]. American Journal of Medical Genetics (Semin. Med. Genet.) 1999, 89:58-61.
[23]Andrew E. Czeizel. Ten years of experience in periconcep tional care[J]. European Journal of Obstetrics & Gynecology and Rep roductive Biology,1999,84: 43-49.
[24]钱序,郭志平,王克利等编.妇幼卫生概论[M].复旦大学出版社,2003,10：80.
[25]The American College of Obstetrics and Gynecology for Routine Obstetrical Care, Prenatal Care Guidelines, Community First Health Plans,66-68.
[26]WHO & UNICEF. Antenatal care in developing countries. Promises, achievements and missed Opportunities. An analysis of trends, levels and differentials, 1990-2001.
[27]Villar J, Baagueel H, Piaggio G et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care[J]. The Lancet,2001, (357): 1551-1564.
[28]Antenatal care:routine care for the healthy pregnant women. National collaborating centre for women's and children's health commissioned by the national institute for clinical excellence October 2003. Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists,27 Sussex Place Regent's Park London NW1 4RG..
[29]Department of Health and Human Service. Reproductive, Maternal and Child Health in Eastern Europe and Eurasia: A Comparative Report. P97-109,2003. Division of reproductive health centers for disease control and prevention Atlanta, GA 30333 ORC MACRO DHS 11785 Beltsille Drive Calverton, MD 20705.
[30]BlueCross BlueShield of North Carolina. Prenatal Practice Guidelines. AAP/ACOG Guidelines for Perinatal Care,5th Edition,2002.
[31]Royal Women's Hospital Clinical Practice Guideline's:Antenatal care schedule-routine low risk.
[32]GAC (Guidelines Advisory Committee). Summary of recommended guidelines prenatal care. Institute for clinical systems improvement. Routine prenatal care(2002)[R]. Health care guidelines 1-65. Released 08/2002.
[33]张爱珍.453例孕产妇产前检查产后访视情况分析[J].中国妇幼保健,2006,21(9)：1195.
[34]薛玉凤,王新立,卢安等.河北省孕产妇卫生保健现状调查[J].中国妇幼保健,2005,20(15)：1971-1972.
[35]方利文,楼超华,高尔生.中国已婚育龄妇女产前保健服务研究[J].中国妇幼保健,2005,20(12)：1424-1426.
[36]广东省助产技术服务基本条件.广东省卫生局.粤卫(2003)47号.
[37]华嘉增.产时保健的新模式[J].中国实用妇科与产科杂,2001,(5)：263-264.
[38]关于进一步加强本市产科质量管理工作的通知.http://wsj.sh.gov.cn
[39]Technical Working Group. Postpartum Care of the Mother and Newborn (WHO/RHT/MSM/98.3)[R].1998.
[40]J Midwifery. A Critical Review of Postpartum Health Relative to Method of Delivery[J]. Womens Health,2006,51(4):242-248.
[41]World Health Organization. Antenatal care[R],1996.
[1]卫生部,农村孕产妇系统保健管理办法(试行),1989.
[2]卫生部,全国城市围产保健管理办法(试行),1987.
[3]Jack BW, Culpepper L. Preconcep tion care. J Fam Pract,1991,32(3):306-314. House of Commons Health Committee. Maternity services:p reconception. Health Committee fourth report. London, HMSO,1991.
[4]陈功,宋新明,王海涛等.孕前保健的效果和收益.中国计划生育学杂志,2006,133(11)：657-659.
[5]Reynolds H.D. Preconception care:An integral part of primary care for women[J]. Journal of nurse-midwifery,1998,43(6):445-458.
[6]Moos MK. Preconceptional health promotion: A health education opportunity for all women. Women Health,1989,15:55-68.
[7]Moos MK, Bangdiwala SI, Meihborn AR, Cefalo RC. The impact of a preconceptional health promotion program on the intendendness of pregnancy. Am J Perinatol,1996,13:103-108.
[8]Carol C. Korenbrot, Alycia Steinberg, Catherine Bender, and SydneNewberry. Preconception Care:A Systematic Review. Maternal and Child Health Journal,2002: 6 (2):75-88.
[9]Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA. Preconcep tion management of insulin - dependent diabetes:Improvement of pregnancy outcome. Obstet Gynecol,1991,77:846-849.
[10]Andrew E. Czeizel. Ten years of experience in periconceptional care. European Journal of Obstetrics & Gynecology and Reproductive Biolo2gy,1999,84:43-49.
[11]Floyd RL, Ebrahim SH, Boyle CA, Gould DW. Observation from the CDC. Prevention alcohol - exposed pregnancies among women of childbearing age:The necessary of a p reconceptional app roach. J Women's Health Gen BasedMed,1999,8: 733-736.
[12]Scheffler RM, Feuchtbaum LB, Phibbs CS. Prevention: the cost effectiveness of the California diabetes and pregnancy program. Am J Public Health.1992,82:168-175.
[13]卫生部颁布《孕前保健服务工作规范(试行)》.卫生部网站.中央政府门户网站.www.gov.cn.2007年02月27日.
[14]闫明.婚前保健及其现状.中国妇幼保健,2007,22(30)：7333-7334.
[15]Frey, Keith A. Preconception Care by the Nonobstetrical Provider. Mayo Clinic Proceedings,2002,77(5):469-473.
[16]University of Michigan Health System, Guidelines for Clinical Care-Prenatal Care, UMHS Prenatal Care Guideline,2006.6.
[17]MCARE, Pregnatal Care Guidelines[R],2006.1
[18]BlueCross BlueShield of North Carolina, Prenatal Practice Guidelines, AAP/ACOG Guidelines for Perinatal Care,5th Edition,2002.
[19]The American College of Obstetrics and Gynecology for Routine Obstetrical Care, Prenatal Care Guidelines, Community First Health Plans,66-68.
[20]Michael C. LU. Recommendations for Preconception Care. American Family Physician,2007,76(3):397-401.
[21]Atrash, Hani; Jack, Brian W; Johnson, Kay. Preconception care:a 2008 update. Current opinion in Obstetrics and Gynecology,2008,20(6):581-589.
[22]N. Verma, L.R.B. Huber, M.E. Thompson and E. Racine. Prevalence of HIV Testing During Preconception and Prenatal Care among Non-Hispanic Black and White Women. Annals of Epidemiology, Volume 17, Issue 9, September 2007, Pages 750-751.
[23]Dunlop, Anne L, Jack, Brian. Frey, Keith. National Recommendations for Preconception Care:The Essential Role of the Family Physician. Journal of the American Board of Family Medicine,2007,20(1):81-84.
[24]TM Weiser, V Garikapaty, M Lin et al. Association of maternal smoking status on breastfeeding practice + Missouri Pregnancy related assessment and monitoring system 2005. AEP 2007,17(9):723-751.
[25]NL Lee, JM Samet, G Yang et al. Prenatal secondhand smoke exposure and infant birth weight in China[J].
[26]Floyd RL, Ebrahim SH, Boyle CA, Gould DW. Observation from the CDC. Prevention alcohol - exposed pregnancies among women of childbearing age:The necessary of a p reconceptional app roach. J Women's Health Gen BasedMed,1999,8: 733-736.
[27]Melissa A, McDiarmid KG. Preconception brief: Occupational/Envionmental exposures. Maternal child health J(2006),10:S123-S128.
[28]Lumley, J. Watson, L. Watson, M. Bower, C. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[29]Mahomed, K. Gulmezoglu, AM. Maternal iodine supplements in areas of deficiency. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane. Database of Systematic Reviews.3,2007.
[30]Preconception, prenatal and postpartum care. Qual Choice. University hospitals health system.
[31]World health organization (WHO). Mother and baby package:Implementing Safe Motherhood in countries[R]. (WHO/FHE/MSM/94.11 Rev.1) Geneva,1996.
[32]WHO & UNICEF. Antenatal care in developing countries. Promises, achievements and missed Opportunities. An analysis of trends, levels and differentials, 1990-2001.
[33]Villar J, Baagueel H, Piaggio G et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. The Lancet, May 19,2001, vol(357):1551-1564.
[34]Munjanja, Stephen P, Lindmark Gunilla & Nystrom Lennarth. Rondomised controlled trial of a reduced-visits programme of antenatal care in Harare, Zimbabwe. The Lancet: Aug 10,1996, vol(348):364-369. Health & Medical Complete.
[35]Villar J, Carroli G, Khan-Neelofur D, Piaggio G, ulmezoglu M. Patterns for routine antenatal care for low-risk pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[36]Schramm WF.衡量适当产前保健的成本和效益.国外医学卫生经济学分册,1993,10(4)：159-165.
[37]林爱华,方积乾.两地孕产妇产前检查方案的成本效果比较.中国医院统计,1999,6(3)：148-151.
[38]Antenatal care:routine care for the healthy pregnant women. National collaborating centre for women's and children's health commissioned by the national institute for clinical excellence October 2003. Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists,27 Sussex Place Regent's Park London NW1 4RG.
[39]Homer CS. What do we feel about community-based antenatal care. Aust N Z J Public Health,2000,24(6):590-595.
[40]Tucker, J. S.; Hall, M. H.; Howie, P. W. et al. Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians. British Medical Journal,1996,312(7030):554-559。
[41]Villar J, Baagueel H, Piaggio G et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. The Lancet, May 19,2001, vol(357):1551-1564.
[42]Royal Women's Hospital Clinical Practice Guideline's:Antenatal care schedule-routine low risk.
[43]Sikorski J, Wilson J, Clement S et al. A randomized controlled trial comparing two schedules of antenatal visits:the antenatal care. Int J Technol Assess Health Care, 1992,1:46-48.
[44]Blondel B. Some characteristics of antenatal care in 13 European countries. Br J Obstet Gynaecol,1985,92:565-568.
[45]Sen DK, Yusof K & Rajaswari K. Are three antenatal visits enough for low risk mothers? Singapore J Obstet Gynaecol,1991,22:83-86.
[46]Villar J, Garcia P & Walker G. Routine antenatal care. Curr Opin Obstet Gynaecol,1993,5:688-693.
[47]World health organization (WHO), Antenatal Care (WHO/FRH/MSM/96.8), 1996.
[48]World health organization (WHO), Antenatal care randomized trial Manual for the Implementation of the New Model,2002.
[49]World health organization (WHO), Pregnancy, Childbirth, Postpartum and Newborn Care:A guide for essential practice, ISBN 92 4 159084 X (NLM classification: WQ 175),2006.2nd edtion12.
[50]Sue J; Thomas, Jane. Antenatal breast examination for promoting breastfeeding. The Cochrane Library, Copyright 2008, The Cochrane Collaboration.2888,3.
[51]Neilson, JP. Symphysis-fundal height measurement in pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[52]World health organization (WHO), Antenatal care randomized trial Manual for the Implementation of the New Model,2002.
[53]Bricker, L. Neilson, JP. Routine Doppler ultrasound in pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[54]Carroli G, Villar J. WHO systematic review of randomized controlled trials of routine antenatal care. Lancet,2001,357(9268):1565-1570.
[55]Crowther, CA; Middleton, P. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,3.
[56]Neilson, JP. Ultrasound for fetal assessment in early pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[57]Carroli G, Villar J. WHO systematic review of randomized controlled trials of routine antenatal care. Lancet,2001,357(9268):1565-1570.
[58]Lian ZH, Zack MM & Erickson JD. Paternal age and the occurrence of birth defects[J]. Am J Hum Genet,1986,39:648.
[59]Smaill, F; Vazquez, JC. Antibiotics for asymptomatic bacteriuria in pregnancy. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,3.
[60]Ades, A E; Sculpher, M J; Gibb, D M, et al. Cost effectiveness analysis of antenatal HIV screening in United Kingdom. British Medical Journal,1999, 319(7219):1230-1234
[61]Peyron, F; Wallon, M; Liou, C; Garner, P. Treatments for toxoplasmosis in pregnancy. The Cochrane Library, Copyright 2008, The Cochrane Collaboration, 2008,3.
[62]GAC (Guidelines Advisory Committee). Summary of recommended guidelines prenatal care. Institute for clinical systems improvement. Routine prenatal care(2002). Health care guidelines 1-65. Released 08/2002.
[63]Omtzigt, Anne-Mieke W. J.; Reuwer, Paul J. H. M.; Bruinse, Hein W. A Randomized Controlled Trial on the Clinical Value of Umbilical Doppler Velocimetry in Antenatal Care. American Journal of Obstetrics and Gynecology,1994,170(2): 625-634.
[64]Pattison, N. McCowan, L. Cardiotocography for antepartum fetal assessment. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[65]Brown, HC; Smith, HJ. Giving women their own case notes to carry during pregnancy. The Cochrane Library, Copyright 2008, The Cochrane Collaboration, 2008,3.
[66]Hodnett, ED; Gates, S; Hofmeyr, GJ; Sakala, C. Continuous support for women during childbirth. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[67]Hodnett, Ellen D. Continuity of caregivers for care during pregnancy and childbirth. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008, 4.
[68]Lewis, L; Webster, J; Carter, A; McVeigh, C; Devenish-Meares, P. Maternal positions and mobility during first stage labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[69]Singata, M; Tranmer, JE. Restricting oral fluid and food intake during labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[70]Prendiville, Walter JP; Elbourne, Diana; McDonald, Susan J. Active versus expectant management in the third stage of labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[71]Su, LL; Chong, YS; Samuel, M. Oxytocin agonists for preventing postpartum haemorrhage. The Cochrane Library, Copyright 2008, The Cochrane Collaboration, 2008,4.
[72]Cotter, A; Ness, A; Tolosa, J. Prophylactic oxytocin for the third stage of labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[73]Liabsuetrakul, T; Choobun, T; Peeyananjarassri, K; Islam, QM. Prophylactic use of ergot alkaloids in the third stage of labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[74]East, Christine E; Chan, Fung Yee; Colditz, Paul B; Begg, Lisa. Fetal pulse oximetry for fetal assessment in labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[75]Lavender, Tina; Hart, Anna; Smyth, Rebecca. Effect of partogram use on outcomes for women in spontaneous labour at term. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[76]Graham, Ernest M.; Petersen, Scott M.; Christo, Dana K, et al. Intrapartum Electronic Fetal Heart Rate Monitoring and the Prevention of Perinatal Brain Injury. The American College of Obstetricians and Gynecologists,2006,108(3):656-666.
[77]Carroli, G. Belizan, J. Episiotomy for vaginal birth. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2006,3.
[78]Reveiz, L; Gaitan, HG; Cuervo, LG. Enemas during labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[79]Basevi, Vittorio; Lavender, Tina. Routine perineal shaving on admission in labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[1]陈玉祥,朱桂龙.科学选择的理论、方法及应用[M].北京：机械工业出版社,1994：221-238.
[2]曾光.现代流行病学方法与应用[M].北京：北京医科大学中国协和医科大学 联合出版社,1994：250-253；255-259.
[3]董恒进,陈英耀,吕军等.医学技术评估的内容与方法[J].中华医院管理杂志,1998,12(14)：709-711.
[4]成刚,王成岗,孟庆跃.应用层次分析法建立卫生技术综合评价指标体系[J].中国卫生资源,2006,9,9(5)：231-232.
[1]曾光.现代流行病学方法与应用.北京：北京医科大学中国协和医科大学联合出版社,1994：250-253；255-259.
[2]Mahomed K. Iron and folate supplementation in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[3]Pena-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[4]Breymann C. Iron deficiency and anaemia in pregnancy: modern aspects of diagnosis and therapy[J]. Blood Cells Molecules & Diseases,2002,29(3):506-516.
[5]Antenatal care:routine care for the healthy pregnant women. National collaborating centre for women's and children's health commissioned by the national institute for clinical excellence October 2003. Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists,27 Sussex Place Regent's Park London NW1 4RG.
[6]Reveiz L,. Gyte GM, Cuervo LG. Treatments for iron-deficiency anaemia in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[7]University of Michigan Health System, Guidelines for Clinical Care-Prenatal Care, UMHS Prenatal Care Guideline,2006.6.
[8]Whittle MJ. Antenatal serology testing in pregnancy[J]. British Journal of Obstetrics and Gynaecology,1996,103:195-196.
[9]李晓燕,吴擢春,汪涛等.中国妇女剖宫产率及其影响因素[J].中国公共卫生,2006,22(1)：1-2.
[10]丰有吉,沈铿.妇产科学[M].人民卫生出版社,2006.
[11]张恒贤,李英伟,孟祥红等.孕妇血型IgG抗体效价预测新生儿溶血病的价值[J].现代中西医结合杂志,2009,18(7)：750.
[12]Neilson, JP. Ultrasound for fetal assessment in early pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[13]Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks' gestation)[J]. Cochrane Database of Systematic Reviews,2009,4.
[14]Crowther CA, Kornman L, O’Callaghan S, George K, Furness M, Willson K. Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial[J]. British Journal of Obstetrics and Gynaecology,1999,106: 1273-1279.
[15]Sharif K, Whittle M. Routine antenatal fetal heart rate auscultation: is it necessary[J]? Journal of Obstetrics and Gynaecology,1993,13:111-113.
[16]Sandmire HF, DeMott RK. Auscultation of the fetal heart presents advantages over electronic monitoring[J]. Wisconsin Medical Journal,1995,94(12):661-663.
[17]Toth A, Szabo J. Ethical aspects of disclosing information on prenatal screening for Down's syndrome[J]. Orvosi Hetilap,2005,146(6):259-265.
[18]Wenstrom KD, Owen J, Chu DC, et al. D-Fetop rotein, free B-human ehorionic gonadotrop in, and dimeric inhibin A produce the best results in a three-analyze, multiple-marker screening test for fetal Down's syndrome[J]. Am J Obstet Gynecol, 1997,177 (5):987-991.
[19]张迅.唐氏综合征的孕期筛查[J].中国实用妇科与产科杂志,2002,18(9)：522.
[20]Smaill. FM, Vazquez. JC. Antibiotics for asymptomatic bacteriuria in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[21]U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy:U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine,2009,150(12):869-873.
[22]石理兰,张琳,赵桂珍.妊娠合并乙肝病毒感染的流行病学研究进展[J].中国实用妇科与产科杂志,2004,20(2)：119-121.
[23]Xu Q, Xiao L, Lu XB, et al. A randomized controlled clinical trial:interruption of intrauterine transmission of hepatitis B virus infection with HBIG[J]. World Journal of Gastroenterology,2006,12(21):3434-3437.
[24]杨筱祎.妊娠合并艾滋病的研究现状及治疗进展[J].国外医学妇幼保健分册,2003,14(4)：226-228.
[25]Volmink. J, Siegfried. N, van der Merwe. L et al. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection[J]. Cochrane Database of Systematic Reviews,2009,4.
[26]Ai Theng Cheong, Ee Ming Khoo. Prevalence of rubella susceptibility among pregnant mothers in a community-based antenatal clinic in Malaysia: a cross-sectional study[J]. Asia-Pacific Journal of Public Health,2008,20(4):340-346.
[27]纪巧云.妊娠合并风疹病毒感染的临床进展[J].社区医学杂志,2007,5(4)：26-29.
[28]Tamer GS, Dundar D, Caliskan E. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in western region of Turkey[J]. Clinical & Investigative Medicine - Medecine Clinique et Experimentale,2009,32(1): E43-47.
[29]项明玉,殷方兰,戴臻等.上海嘉定区2002-2006年妊娠梅毒流行病学分析[J].中国皮肤性病学杂志,2008,22(10)：606-607.
[30]许育娴,房思宁,蔡文德.妊娠合并梅毒的流行特征及预后分析[J].现代预防医学,2004,31(3)：411-412.
[31]Walker, Godfrey JA. Antibiotics for syphilis diagnosed during pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[32]承春红.妊娠合并淋病[J].中国实用乡村医生杂志,2006,13(5)：4-5.
[33]Brocklehurst, Peter. Antibiotics for gonorrhoea in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[34]Alto WA. No need for glycosuria/proteinuria screen in pregnant women[J]. Journal of Family Practice,2005,54(11):978-983.
[35]Hillier TA, Vesco KK, Pedula KL, et al. Screening for gestational diabetes mellitus:a systematic review for the U.S. Preventive Services Task Force[J]. Annals of Internal Medicine,2008,148(10):766-75.
[36]珀金斯.妊娠糖尿病筛查、诊断及回顾[J].糖尿病天地临床刊,2009,3(3)：112-116.
[37]Serlin DC, Lash RW. Diagnosis and management of gestational diabetes mellitus[J]. American Family Physician,2009,80(1):57-62.
[38]唐英,刘关键,杨太珠.孕早期超声筛查胎儿结构畸形的循证病案讨论[J].中国循证医学杂志,2009,9(6)：705-708.
[39]李蔓,吴青青,王嵬.妊娠早中期超声筛查胎儿畸形研究进展[J].中国医学影像技术,2007,23(11)：1745-1747.
[40]余志红,王慧芳,林琪等.中孕期胎儿超声筛查切面的规范化探讨[J].中华超声影像学杂志,2005,14(1)：39-41.
[41]World Health Organization(WHO). Antenatal Care (WHO/FRH/MSM/96.8), 1996.
[42]Shanwell A, Sallander S, Bremme K, Westgren M. Clinical evaluation of a solid-phase test for red cell antibody screening of pregnant women[J]. Transfusion, 1999,39:26-31.
[43]Crowther CA, Kornman L, O'Callaghan S, George K, Furness M, Willson K. Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial. [see comments]. British Journal of Obstetrics and Gynaecology 1999; 106:1273-9.
[44]刘芙蓉,杜跃冬.7170例孕妇乙肝病毒感染调查[J].河南预防医学杂志,2000,11(4)：229-230.
[45]Alcalde Encinas MM, Moreno Guillen S, Pinera Salmeron P, et al. Pregnancy and HIV infection: the need for routine serological evaluation[J]. Revista Clinica Espanola,1999,199(9):569-572.
[46]纪巧云.妊娠合并风疹病毒感染的临床进展[J].社区医学杂志,2007,5(4)：26-29.
[47]Walker GJ. Antibiotics for syphilis diagnosed during pregnancy[J]. Cochrane Database of Systematic Reviews,2001, (3):CD001143.
[48]Brocklehurst, P. Antibiotics for gonorrhoea in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[49]Alto WA. No need for glycosuria/proteinuria screen in pregnant women[J]. Journal of Family Practice,2005,54(11):978-983.
[50]马毅,吴效科,牛铭刚等.妊娠期尿糖阳性产妇妊娠结局的临床研究[J].中国初级卫生保健,2006,20(11)：26-27.
[51]Pathak S, Lees C. Ultrasound structural fetal anomaly screening: an update[J]. Archives of Disease in Childhood Fetal & Neonatal Edition,2009,94(5):F384-90.
[52]卫生部,农村孕产妇系统保健管理办法(试行),1989.
[53]卫生部,全国城市围产保健管理办法(试行),1987.
[54]方利文,楼超华,高尔生.中国已婚育龄妇女产前保健服务研究[J].中国妇幼保健,2005,20(12)：1424-1426.
[55]张爱珍,453例孕产妇产前检查产后访视情况分析,中国妇幼保健,2006；21(9)：1195.
[56]肖杏琴,谢文娟,黄幼琴,责任街道孕产妇系统保健情况分析,上海预防医学,2005.02.20：17(2)：81-82.
[1]《儿童生存、保护和发展的世界宣言》. http://www.xinhuanet.com
[2]http://www.gov.cn
[3]联合国前年宣言.第五十五届会议.http://www.un.org
[4]中华人民共和国卫生部.中国卫生统计年鉴[M].北京：人民卫生出版社,2007.
[5]http://www.moh.gov.cn
[6]http://www.mchscn.org
[7]2009-2012年母婴保健行业发展前景分析及投资风险预测报告,2009.9中商情报网http://www.asdci.com.
[8]《2008年世界卫生统计》.http://www.un.org.
[9]全国孕产妇死亡监测协作组.全国孕产妇死亡监测结果分析[J].中华妇产科杂志,1999,34(11)：645-648.
[10]叶文芸.重度高危孕产妇810例分析及护理对策.解放军护理杂志.2006,23(9)：55-56.
[11]中国卫生统计年鉴.中华人民共和国卫生部编.中国协和医科大学出版社,2008,7,第一版.
[12]虞海伦.《婚姻登记条例》实施后孕产妇保健工作面临的困难和对策[J].中国妇幼保健,2008,20(20)：2625-2627.
[13]崔颖,瞿群,杨丽等.中国西部农村3岁以下儿童贫血状况分析.中国公共卫生,2008,24(9)：1052-1055.
[14]唐礼榕,郝模.我国孕产妇系统管理发展及面临的主要问题[J].中国医药指南,2005,3(4)：450-452.
[15]朱增柏,刘群,边爱玲.浅谈城镇社区妇幼保健管理[J].社区医学杂 志,2004,2(3)：36-37.
[16]吴健明,郑艺霞,洪鹏忠.建立与探索社区卫生服务妇幼卫生保健质量绩效评价体系[J].中国社区医师,2006,8(2)：97-98.
[17]周敏霞.区级妇幼保健机构生存与发展的思考和对策[J].中国农村卫生事业管理,2006,26(9)：65-66.
[18]刘利群,周小军.全国社区卫生服务机构基本情况调查分析[J].中华医院管理杂志,2003,19(8)：485-490.
[19]孟仲莹,等.城市社区妇幼保健管理工作的做法和体会[J].1998,4(13)：217-219.
[20]沈汝,刘凯波,肖殉,等.流动入口孕产妇保健及分娩调查[J].中国公共卫生,2004,20(1)：46-47.
[21]陈刚,吕军,张德英,等.流动人口妇女儿童卫生保健服务现状及对策研究概述[J].中国全科医学,2006,9(7)：541-543.
[22]高惠琦,乔磊,黄敬亨.世界卫生组织人人享有卫生保健战略的由来和发展[J].中国初级卫生保健,2004,18(8)：3-5.
[23]Carroll G, Villar J, Piaggio G, et al. WHO systematic review of randomised controlled trials of routine antenatal care [J]. Lancet,2001,357 (9628):1565-1570.
[24]Williams S, Dickson D, Forbes J, et al. An evaluation of community antenatal care[J]. Midwifery,1989,5(2):63-68.
[25]杨惠娟,沈汝,李禾等.国外社区孕产妇保健研究现状[J].实用预防医学,2008,15(3)：963-966.
[26]Roemer, MI. National Health Systems throughout the World[J]. Annu Rev Public Health,1993,14:335-353.
[27]Hedgecock J, Castro M, Cruikshank WB. Community health centers:a resource for service and training[J]. Henry Ford Hosp Med J,1992,40(1-2):45-49.
[28]DW Edington, Y Louis, Kuku Li. Recent trends in the development of the health management[J]. Health management research,2001,76(103):140-147.
[29]Dowswell T, Renfrew MJ, Gregson B, et al. A review of the literature on women's views on their maternity care in the community in the U K[J]. Midwifery, 2001,17 (3):194-202.
[30]Barnett S, Nair N, Lewycka S, Costello A. Community interventions for maternal and perinatal health[J]. BJOG,2005,112(9):1170-1173.
[31]Homer CS, Davis GK, Brodie PM. What do women feel about community-based antenatal care[J]. Aust N Z J Public Health,2000,24(6):590-595.
[2]World health organization (WHO). Mother and baby package:Implementing Safe Motherhood in countries[R]. (WHO/FHE/MSM/94.11 Rev.1) Geneva,1996.
[3]全国孕产妇死亡监测协作组.全国孕产妇死亡监测结果分析[J].中华妇产科杂志,1999,34(11)：645-648.
[4]徐香芬.永康市2002-2004年高危孕产妇监测情况分析[J].中国妇幼保健.2006,(21)：184-185
[5]高惠琦,乔磊,黄敬亨.世界卫生组织人人享有卫生保健战略的由来和发展[J].中国初级卫生保健,2004,18(8)：3-5.
[6]Carroll G, Villar J, Piaggio G, et al. WHO systematic review of randomised controlled trials of routine antenatal care [J]. Lancet,2001,357 (9628):1565-1570.
[7]联合国儿童基金会中国办事处.[EB/OL]. http://www.unicef.org/china/zh/health. html.
[8]方利文,楼超华,高尔生.中国已婚育龄妇女产前保健服务研究[J].中国妇幼保健,2005,20(12)：1424-1426.
[9]叶文芸.重度高危孕产妇810例分析及护理对策[J].解放军护理杂志.2006,23(9)：55-56
[10]陈洁主编.医学技术评估[M].上海医科大学出版社,1996年8月第1版.
[11]冯皓.医疗保健技术评估的理论与方法[J].国外医学·医院管理分册,1994,(1)：1-7.
[1]郭鑫,邓丽娜.归纳演绎在管理学中的应用[J.]合作经济与科技,2006,(7)：22-23.
[2]郑文晖.文献计量法与内容分析法的比较研究[J].情报杂志,2006,(5)：31-33.
[3]邹菲.内容分析法的理论与实践研究[J].评价与管理,2006,(4)：71-77.
[4]郑文晖.文献计量法与内容分析法的比较研究[J].情报杂志,2006,(5)：31-33.
[5]陈英耀主编.卫生服务评价[M].复旦大学出版社,2007,3.
[1]World health organization (WHO). Mother and baby package:Implementing Safe Motherhood in countries[R]. (WHO/FHE/MSM/94.11 Rev.1) Geneva,1996.
[2]卫生部,孕前保健服务工作规范(试行),2007.
[3]上海市卫生局,上海市孕产期系统保健工作规范,2002.
[4]National Collaborating Centre for Womens's and Children's Health, Antenatal Care-routine care for the healthy pregnant woman, ISBN 1900364 913,2003.10
[5]University of Michigan Health System, Guidelines for Clinical Care-Prenatal Care, UMHS Prenatal Care Guideline,2006.6
[6]卫生部.全国城市围产保健管理办法.http://wsi.sh.gov.cn.
[7]World health organization (WHO). Antenatal care randomized trial Manual for the Implementation of the New Model[R].2002.
[8]卫生部.农村孕产妇系统保健管理办法(试行),1989.
[9]广东省助产技术服务基本条件.广东省卫生局.粤卫(2003)47号.
[10]周虹,钟玲,刘建等.社会因素剖宫产及剖宫产率的临床评价[J].实用妇产科杂志,2007,23(10)：736-737.
[11]华嘉增.产时保健的新模式[J].中国实用妇科与产科杂,2001,(5)：263-264.
[12]World health organization (WHO). Pregnancy, Childbirth, Postpartum and Newborn Care:A guide for essential practice[R]. ISBN 92 4 159084 X (NLM classification: WQ 175),2006.2nd edtion.
[13]郑晓瑛,陈嵘,张蕾.孕前-围孕保健的ACI模式[J].中国计划生育学杂志,2006,11(133)：652-655.
[14]University of Michigan Health System. Guidelines for Clinical Care-Prenatal Care. UMHS Prenatal Care Guideline,2006,6.
[15]Preconception care is crucial to improving maternal and infant health[R]. Medical letter on the CDC & FDA. Atlanta: Oct 22,2006:86.
[16]Alexander D. Allaire & Robert C. Cefalo. Preconceptional health care model[J]. European journal of Obstetrics & Gynecology and reproductive biology,1998,78(2): 163-168.
[17]Reynolds H.D. Preconception care:An integral part of primary care for women[J]. Journal of nurse-midwifery,1998,43(6):445-458.
[18]Lynnl S, Barbaras A. Preconceptual obstetric risk assessment and health promotion[J]. American Family Physician,1995,51:1878.
[19]Lu, Michael C. Recommendations for Preconception Care[J]. American Family Physician,2007,76(3):397-400.
[20]Atrash, Hani; Jack, Brian W; Johnson, Kay. Preconception care:a 2008 update[J]. Current opinion in Obstetrics & Gynecology,2008,20(6):581-589.
[21]Moos MK. Preconceptional health promotion: A health education opportunity for all women[J]. Women Health,1989,15:55-68.
[22]Connie Schrander-Stumpel. Preconception Care:Challenge of the New Millennium?[J]. American Journal of Medical Genetics (Semin. Med. Genet.) 1999, 89:58-61.
[23]Andrew E. Czeizel. Ten years of experience in periconcep tional care[J]. European Journal of Obstetrics & Gynecology and Rep roductive Biology,1999,84: 43-49.
[24]钱序,郭志平,王克利等编.妇幼卫生概论[M].复旦大学出版社,2003,10：80.
[25]The American College of Obstetrics and Gynecology for Routine Obstetrical Care, Prenatal Care Guidelines, Community First Health Plans,66-68.
[26]WHO & UNICEF. Antenatal care in developing countries. Promises, achievements and missed Opportunities. An analysis of trends, levels and differentials, 1990-2001.
[27]Villar J, Baagueel H, Piaggio G et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care[J]. The Lancet,2001, (357): 1551-1564.
[28]Antenatal care:routine care for the healthy pregnant women. National collaborating centre for women's and children's health commissioned by the national institute for clinical excellence October 2003. Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists,27 Sussex Place Regent's Park London NW1 4RG..
[29]Department of Health and Human Service. Reproductive, Maternal and Child Health in Eastern Europe and Eurasia: A Comparative Report. P97-109,2003. Division of reproductive health centers for disease control and prevention Atlanta, GA 30333 ORC MACRO DHS 11785 Beltsille Drive Calverton, MD 20705.
[30]BlueCross BlueShield of North Carolina. Prenatal Practice Guidelines. AAP/ACOG Guidelines for Perinatal Care,5th Edition,2002.
[31]Royal Women's Hospital Clinical Practice Guideline's:Antenatal care schedule-routine low risk.
[32]GAC (Guidelines Advisory Committee). Summary of recommended guidelines prenatal care. Institute for clinical systems improvement. Routine prenatal care(2002)[R]. Health care guidelines 1-65. Released 08/2002.
[33]张爱珍.453例孕产妇产前检查产后访视情况分析[J].中国妇幼保健,2006,21(9)：1195.
[34]薛玉凤,王新立,卢安等.河北省孕产妇卫生保健现状调查[J].中国妇幼保健,2005,20(15)：1971-1972.
[35]方利文,楼超华,高尔生.中国已婚育龄妇女产前保健服务研究[J].中国妇幼保健,2005,20(12)：1424-1426.
[36]广东省助产技术服务基本条件.广东省卫生局.粤卫(2003)47号.
[37]华嘉增.产时保健的新模式[J].中国实用妇科与产科杂,2001,(5)：263-264.
[38]关于进一步加强本市产科质量管理工作的通知.http://wsj.sh.gov.cn
[39]Technical Working Group. Postpartum Care of the Mother and Newborn (WHO/RHT/MSM/98.3)[R].1998.
[40]J Midwifery. A Critical Review of Postpartum Health Relative to Method of Delivery[J]. Womens Health,2006,51(4):242-248.
[41]World Health Organization. Antenatal care[R],1996.
[1]卫生部,农村孕产妇系统保健管理办法(试行),1989.
[2]卫生部,全国城市围产保健管理办法(试行),1987.
[3]Jack BW, Culpepper L. Preconcep tion care. J Fam Pract,1991,32(3):306-314. House of Commons Health Committee. Maternity services:p reconception. Health Committee fourth report. London, HMSO,1991.
[4]陈功,宋新明,王海涛等.孕前保健的效果和收益.中国计划生育学杂志,2006,133(11)：657-659.
[5]Reynolds H.D. Preconception care:An integral part of primary care for women[J]. Journal of nurse-midwifery,1998,43(6):445-458.
[6]Moos MK. Preconceptional health promotion: A health education opportunity for all women. Women Health,1989,15:55-68.
[7]Moos MK, Bangdiwala SI, Meihborn AR, Cefalo RC. The impact of a preconceptional health promotion program on the intendendness of pregnancy. Am J Perinatol,1996,13:103-108.
[8]Carol C. Korenbrot, Alycia Steinberg, Catherine Bender, and SydneNewberry. Preconception Care:A Systematic Review. Maternal and Child Health Journal,2002: 6 (2):75-88.
[9]Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA. Preconcep tion management of insulin - dependent diabetes:Improvement of pregnancy outcome. Obstet Gynecol,1991,77:846-849.
[10]Andrew E. Czeizel. Ten years of experience in periconceptional care. European Journal of Obstetrics & Gynecology and Reproductive Biolo2gy,1999,84:43-49.
[11]Floyd RL, Ebrahim SH, Boyle CA, Gould DW. Observation from the CDC. Prevention alcohol - exposed pregnancies among women of childbearing age:The necessary of a p reconceptional app roach. J Women's Health Gen BasedMed,1999,8: 733-736.
[12]Scheffler RM, Feuchtbaum LB, Phibbs CS. Prevention: the cost effectiveness of the California diabetes and pregnancy program. Am J Public Health.1992,82:168-175.
[13]卫生部颁布《孕前保健服务工作规范(试行)》.卫生部网站.中央政府门户网站.www.gov.cn.2007年02月27日.
[14]闫明.婚前保健及其现状.中国妇幼保健,2007,22(30)：7333-7334.
[15]Frey, Keith A. Preconception Care by the Nonobstetrical Provider. Mayo Clinic Proceedings,2002,77(5):469-473.
[16]University of Michigan Health System, Guidelines for Clinical Care-Prenatal Care, UMHS Prenatal Care Guideline,2006.6.
[17]MCARE, Pregnatal Care Guidelines[R],2006.1
[18]BlueCross BlueShield of North Carolina, Prenatal Practice Guidelines, AAP/ACOG Guidelines for Perinatal Care,5th Edition,2002.
[19]The American College of Obstetrics and Gynecology for Routine Obstetrical Care, Prenatal Care Guidelines, Community First Health Plans,66-68.
[20]Michael C. LU. Recommendations for Preconception Care. American Family Physician,2007,76(3):397-401.
[21]Atrash, Hani; Jack, Brian W; Johnson, Kay. Preconception care:a 2008 update. Current opinion in Obstetrics and Gynecology,2008,20(6):581-589.
[22]N. Verma, L.R.B. Huber, M.E. Thompson and E. Racine. Prevalence of HIV Testing During Preconception and Prenatal Care among Non-Hispanic Black and White Women. Annals of Epidemiology, Volume 17, Issue 9, September 2007, Pages 750-751.
[23]Dunlop, Anne L, Jack, Brian. Frey, Keith. National Recommendations for Preconception Care:The Essential Role of the Family Physician. Journal of the American Board of Family Medicine,2007,20(1):81-84.
[24]TM Weiser, V Garikapaty, M Lin et al. Association of maternal smoking status on breastfeeding practice + Missouri Pregnancy related assessment and monitoring system 2005. AEP 2007,17(9):723-751.
[25]NL Lee, JM Samet, G Yang et al. Prenatal secondhand smoke exposure and infant birth weight in China[J].
[26]Floyd RL, Ebrahim SH, Boyle CA, Gould DW. Observation from the CDC. Prevention alcohol - exposed pregnancies among women of childbearing age:The necessary of a p reconceptional app roach. J Women's Health Gen BasedMed,1999,8: 733-736.
[27]Melissa A, McDiarmid KG. Preconception brief: Occupational/Envionmental exposures. Maternal child health J(2006),10:S123-S128.
[28]Lumley, J. Watson, L. Watson, M. Bower, C. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[29]Mahomed, K. Gulmezoglu, AM. Maternal iodine supplements in areas of deficiency. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane. Database of Systematic Reviews.3,2007.
[30]Preconception, prenatal and postpartum care. Qual Choice. University hospitals health system.
[31]World health organization (WHO). Mother and baby package:Implementing Safe Motherhood in countries[R]. (WHO/FHE/MSM/94.11 Rev.1) Geneva,1996.
[32]WHO & UNICEF. Antenatal care in developing countries. Promises, achievements and missed Opportunities. An analysis of trends, levels and differentials, 1990-2001.
[33]Villar J, Baagueel H, Piaggio G et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. The Lancet, May 19,2001, vol(357):1551-1564.
[34]Munjanja, Stephen P, Lindmark Gunilla & Nystrom Lennarth. Rondomised controlled trial of a reduced-visits programme of antenatal care in Harare, Zimbabwe. The Lancet: Aug 10,1996, vol(348):364-369. Health & Medical Complete.
[35]Villar J, Carroli G, Khan-Neelofur D, Piaggio G, ulmezoglu M. Patterns for routine antenatal care for low-risk pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[36]Schramm WF.衡量适当产前保健的成本和效益.国外医学卫生经济学分册,1993,10(4)：159-165.
[37]林爱华,方积乾.两地孕产妇产前检查方案的成本效果比较.中国医院统计,1999,6(3)：148-151.
[38]Antenatal care:routine care for the healthy pregnant women. National collaborating centre for women's and children's health commissioned by the national institute for clinical excellence October 2003. Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists,27 Sussex Place Regent's Park London NW1 4RG.
[39]Homer CS. What do we feel about community-based antenatal care. Aust N Z J Public Health,2000,24(6):590-595.
[40]Tucker, J. S.; Hall, M. H.; Howie, P. W. et al. Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians. British Medical Journal,1996,312(7030):554-559。
[41]Villar J, Baagueel H, Piaggio G et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. The Lancet, May 19,2001, vol(357):1551-1564.
[42]Royal Women's Hospital Clinical Practice Guideline's:Antenatal care schedule-routine low risk.
[43]Sikorski J, Wilson J, Clement S et al. A randomized controlled trial comparing two schedules of antenatal visits:the antenatal care. Int J Technol Assess Health Care, 1992,1:46-48.
[44]Blondel B. Some characteristics of antenatal care in 13 European countries. Br J Obstet Gynaecol,1985,92:565-568.
[45]Sen DK, Yusof K & Rajaswari K. Are three antenatal visits enough for low risk mothers? Singapore J Obstet Gynaecol,1991,22:83-86.
[46]Villar J, Garcia P & Walker G. Routine antenatal care. Curr Opin Obstet Gynaecol,1993,5:688-693.
[47]World health organization (WHO), Antenatal Care (WHO/FRH/MSM/96.8), 1996.
[48]World health organization (WHO), Antenatal care randomized trial Manual for the Implementation of the New Model,2002.
[49]World health organization (WHO), Pregnancy, Childbirth, Postpartum and Newborn Care:A guide for essential practice, ISBN 92 4 159084 X (NLM classification: WQ 175),2006.2nd edtion12.
[50]Sue J; Thomas, Jane. Antenatal breast examination for promoting breastfeeding. The Cochrane Library, Copyright 2008, The Cochrane Collaboration.2888,3.
[51]Neilson, JP. Symphysis-fundal height measurement in pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[52]World health organization (WHO), Antenatal care randomized trial Manual for the Implementation of the New Model,2002.
[53]Bricker, L. Neilson, JP. Routine Doppler ultrasound in pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[54]Carroli G, Villar J. WHO systematic review of randomized controlled trials of routine antenatal care. Lancet,2001,357(9268):1565-1570.
[55]Crowther, CA; Middleton, P. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,3.
[56]Neilson, JP. Ultrasound for fetal assessment in early pregnancy. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[57]Carroli G, Villar J. WHO systematic review of randomized controlled trials of routine antenatal care. Lancet,2001,357(9268):1565-1570.
[58]Lian ZH, Zack MM & Erickson JD. Paternal age and the occurrence of birth defects[J]. Am J Hum Genet,1986,39:648.
[59]Smaill, F; Vazquez, JC. Antibiotics for asymptomatic bacteriuria in pregnancy. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,3.
[60]Ades, A E; Sculpher, M J; Gibb, D M, et al. Cost effectiveness analysis of antenatal HIV screening in United Kingdom. British Medical Journal,1999, 319(7219):1230-1234
[61]Peyron, F; Wallon, M; Liou, C; Garner, P. Treatments for toxoplasmosis in pregnancy. The Cochrane Library, Copyright 2008, The Cochrane Collaboration, 2008,3.
[62]GAC (Guidelines Advisory Committee). Summary of recommended guidelines prenatal care. Institute for clinical systems improvement. Routine prenatal care(2002). Health care guidelines 1-65. Released 08/2002.
[63]Omtzigt, Anne-Mieke W. J.; Reuwer, Paul J. H. M.; Bruinse, Hein W. A Randomized Controlled Trial on the Clinical Value of Umbilical Doppler Velocimetry in Antenatal Care. American Journal of Obstetrics and Gynecology,1994,170(2): 625-634.
[64]Pattison, N. McCowan, L. Cardiotocography for antepartum fetal assessment. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews.3,2007.
[65]Brown, HC; Smith, HJ. Giving women their own case notes to carry during pregnancy. The Cochrane Library, Copyright 2008, The Cochrane Collaboration, 2008,3.
[66]Hodnett, ED; Gates, S; Hofmeyr, GJ; Sakala, C. Continuous support for women during childbirth. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[67]Hodnett, Ellen D. Continuity of caregivers for care during pregnancy and childbirth. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008, 4.
[68]Lewis, L; Webster, J; Carter, A; McVeigh, C; Devenish-Meares, P. Maternal positions and mobility during first stage labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[69]Singata, M; Tranmer, JE. Restricting oral fluid and food intake during labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[70]Prendiville, Walter JP; Elbourne, Diana; McDonald, Susan J. Active versus expectant management in the third stage of labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[71]Su, LL; Chong, YS; Samuel, M. Oxytocin agonists for preventing postpartum haemorrhage. The Cochrane Library, Copyright 2008, The Cochrane Collaboration, 2008,4.
[72]Cotter, A; Ness, A; Tolosa, J. Prophylactic oxytocin for the third stage of labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[73]Liabsuetrakul, T; Choobun, T; Peeyananjarassri, K; Islam, QM. Prophylactic use of ergot alkaloids in the third stage of labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[74]East, Christine E; Chan, Fung Yee; Colditz, Paul B; Begg, Lisa. Fetal pulse oximetry for fetal assessment in labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[75]Lavender, Tina; Hart, Anna; Smyth, Rebecca. Effect of partogram use on outcomes for women in spontaneous labour at term. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[76]Graham, Ernest M.; Petersen, Scott M.; Christo, Dana K, et al. Intrapartum Electronic Fetal Heart Rate Monitoring and the Prevention of Perinatal Brain Injury. The American College of Obstetricians and Gynecologists,2006,108(3):656-666.
[77]Carroli, G. Belizan, J. Episiotomy for vaginal birth. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2006,3.
[78]Reveiz, L; Gaitan, HG; Cuervo, LG. Enemas during labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[79]Basevi, Vittorio; Lavender, Tina. Routine perineal shaving on admission in labour. The Cochrane Library, Copyright 2008, The Cochrane Collaboration,2008,4.
[1]陈玉祥,朱桂龙.科学选择的理论、方法及应用[M].北京：机械工业出版社,1994：221-238.
[2]曾光.现代流行病学方法与应用[M].北京：北京医科大学中国协和医科大学 联合出版社,1994：250-253；255-259.
[3]董恒进,陈英耀,吕军等.医学技术评估的内容与方法[J].中华医院管理杂志,1998,12(14)：709-711.
[4]成刚,王成岗,孟庆跃.应用层次分析法建立卫生技术综合评价指标体系[J].中国卫生资源,2006,9,9(5)：231-232.
[1]曾光.现代流行病学方法与应用.北京：北京医科大学中国协和医科大学联合出版社,1994：250-253；255-259.
[2]Mahomed K. Iron and folate supplementation in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[3]Pena-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[4]Breymann C. Iron deficiency and anaemia in pregnancy: modern aspects of diagnosis and therapy[J]. Blood Cells Molecules & Diseases,2002,29(3):506-516.
[5]Antenatal care:routine care for the healthy pregnant women. National collaborating centre for women's and children's health commissioned by the national institute for clinical excellence October 2003. Published by the RCOG Press at the Royal College of Obstetricians and Gynaecologists,27 Sussex Place Regent's Park London NW1 4RG.
[6]Reveiz L,. Gyte GM, Cuervo LG. Treatments for iron-deficiency anaemia in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[7]University of Michigan Health System, Guidelines for Clinical Care-Prenatal Care, UMHS Prenatal Care Guideline,2006.6.
[8]Whittle MJ. Antenatal serology testing in pregnancy[J]. British Journal of Obstetrics and Gynaecology,1996,103:195-196.
[9]李晓燕,吴擢春,汪涛等.中国妇女剖宫产率及其影响因素[J].中国公共卫生,2006,22(1)：1-2.
[10]丰有吉,沈铿.妇产科学[M].人民卫生出版社,2006.
[11]张恒贤,李英伟,孟祥红等.孕妇血型IgG抗体效价预测新生儿溶血病的价值[J].现代中西医结合杂志,2009,18(7)：750.
[12]Neilson, JP. Ultrasound for fetal assessment in early pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[13]Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks' gestation)[J]. Cochrane Database of Systematic Reviews,2009,4.
[14]Crowther CA, Kornman L, O’Callaghan S, George K, Furness M, Willson K. Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial[J]. British Journal of Obstetrics and Gynaecology,1999,106: 1273-1279.
[15]Sharif K, Whittle M. Routine antenatal fetal heart rate auscultation: is it necessary[J]? Journal of Obstetrics and Gynaecology,1993,13:111-113.
[16]Sandmire HF, DeMott RK. Auscultation of the fetal heart presents advantages over electronic monitoring[J]. Wisconsin Medical Journal,1995,94(12):661-663.
[17]Toth A, Szabo J. Ethical aspects of disclosing information on prenatal screening for Down's syndrome[J]. Orvosi Hetilap,2005,146(6):259-265.
[18]Wenstrom KD, Owen J, Chu DC, et al. D-Fetop rotein, free B-human ehorionic gonadotrop in, and dimeric inhibin A produce the best results in a three-analyze, multiple-marker screening test for fetal Down's syndrome[J]. Am J Obstet Gynecol, 1997,177 (5):987-991.
[19]张迅.唐氏综合征的孕期筛查[J].中国实用妇科与产科杂志,2002,18(9)：522.
[20]Smaill. FM, Vazquez. JC. Antibiotics for asymptomatic bacteriuria in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[21]U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy:U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine,2009,150(12):869-873.
[22]石理兰,张琳,赵桂珍.妊娠合并乙肝病毒感染的流行病学研究进展[J].中国实用妇科与产科杂志,2004,20(2)：119-121.
[23]Xu Q, Xiao L, Lu XB, et al. A randomized controlled clinical trial:interruption of intrauterine transmission of hepatitis B virus infection with HBIG[J]. World Journal of Gastroenterology,2006,12(21):3434-3437.
[24]杨筱祎.妊娠合并艾滋病的研究现状及治疗进展[J].国外医学妇幼保健分册,2003,14(4)：226-228.
[25]Volmink. J, Siegfried. N, van der Merwe. L et al. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection[J]. Cochrane Database of Systematic Reviews,2009,4.
[26]Ai Theng Cheong, Ee Ming Khoo. Prevalence of rubella susceptibility among pregnant mothers in a community-based antenatal clinic in Malaysia: a cross-sectional study[J]. Asia-Pacific Journal of Public Health,2008,20(4):340-346.
[27]纪巧云.妊娠合并风疹病毒感染的临床进展[J].社区医学杂志,2007,5(4)：26-29.
[28]Tamer GS, Dundar D, Caliskan E. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in western region of Turkey[J]. Clinical & Investigative Medicine - Medecine Clinique et Experimentale,2009,32(1): E43-47.
[29]项明玉,殷方兰,戴臻等.上海嘉定区2002-2006年妊娠梅毒流行病学分析[J].中国皮肤性病学杂志,2008,22(10)：606-607.
[30]许育娴,房思宁,蔡文德.妊娠合并梅毒的流行特征及预后分析[J].现代预防医学,2004,31(3)：411-412.
[31]Walker, Godfrey JA. Antibiotics for syphilis diagnosed during pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[32]承春红.妊娠合并淋病[J].中国实用乡村医生杂志,2006,13(5)：4-5.
[33]Brocklehurst, Peter. Antibiotics for gonorrhoea in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[34]Alto WA. No need for glycosuria/proteinuria screen in pregnant women[J]. Journal of Family Practice,2005,54(11):978-983.
[35]Hillier TA, Vesco KK, Pedula KL, et al. Screening for gestational diabetes mellitus:a systematic review for the U.S. Preventive Services Task Force[J]. Annals of Internal Medicine,2008,148(10):766-75.
[36]珀金斯.妊娠糖尿病筛查、诊断及回顾[J].糖尿病天地临床刊,2009,3(3)：112-116.
[37]Serlin DC, Lash RW. Diagnosis and management of gestational diabetes mellitus[J]. American Family Physician,2009,80(1):57-62.
[38]唐英,刘关键,杨太珠.孕早期超声筛查胎儿结构畸形的循证病案讨论[J].中国循证医学杂志,2009,9(6)：705-708.
[39]李蔓,吴青青,王嵬.妊娠早中期超声筛查胎儿畸形研究进展[J].中国医学影像技术,2007,23(11)：1745-1747.
[40]余志红,王慧芳,林琪等.中孕期胎儿超声筛查切面的规范化探讨[J].中华超声影像学杂志,2005,14(1)：39-41.
[41]World Health Organization(WHO). Antenatal Care (WHO/FRH/MSM/96.8), 1996.
[42]Shanwell A, Sallander S, Bremme K, Westgren M. Clinical evaluation of a solid-phase test for red cell antibody screening of pregnant women[J]. Transfusion, 1999,39:26-31.
[43]Crowther CA, Kornman L, O'Callaghan S, George K, Furness M, Willson K. Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial. [see comments]. British Journal of Obstetrics and Gynaecology 1999; 106:1273-9.
[44]刘芙蓉,杜跃冬.7170例孕妇乙肝病毒感染调查[J].河南预防医学杂志,2000,11(4)：229-230.
[45]Alcalde Encinas MM, Moreno Guillen S, Pinera Salmeron P, et al. Pregnancy and HIV infection: the need for routine serological evaluation[J]. Revista Clinica Espanola,1999,199(9):569-572.
[46]纪巧云.妊娠合并风疹病毒感染的临床进展[J].社区医学杂志,2007,5(4)：26-29.
[47]Walker GJ. Antibiotics for syphilis diagnosed during pregnancy[J]. Cochrane Database of Systematic Reviews,2001, (3):CD001143.
[48]Brocklehurst, P. Antibiotics for gonorrhoea in pregnancy[J]. Cochrane Database of Systematic Reviews,2009,4.
[49]Alto WA. No need for glycosuria/proteinuria screen in pregnant women[J]. Journal of Family Practice,2005,54(11):978-983.
[50]马毅,吴效科,牛铭刚等.妊娠期尿糖阳性产妇妊娠结局的临床研究[J].中国初级卫生保健,2006,20(11)：26-27.
[51]Pathak S, Lees C. Ultrasound structural fetal anomaly screening: an update[J]. Archives of Disease in Childhood Fetal & Neonatal Edition,2009,94(5):F384-90.
[52]卫生部,农村孕产妇系统保健管理办法(试行),1989.
[53]卫生部,全国城市围产保健管理办法(试行),1987.
[54]方利文,楼超华,高尔生.中国已婚育龄妇女产前保健服务研究[J].中国妇幼保健,2005,20(12)：1424-1426.
[55]张爱珍,453例孕产妇产前检查产后访视情况分析,中国妇幼保健,2006；21(9)：1195.
[56]肖杏琴,谢文娟,黄幼琴,责任街道孕产妇系统保健情况分析,上海预防医学,2005.02.20：17(2)：81-82.
[1]《儿童生存、保护和发展的世界宣言》. http://www.xinhuanet.com
[2]http://www.gov.cn
[3]联合国前年宣言.第五十五届会议.http://www.un.org
[4]中华人民共和国卫生部.中国卫生统计年鉴[M].北京：人民卫生出版社,2007.
[5]http://www.moh.gov.cn
[6]http://www.mchscn.org
[7]2009-2012年母婴保健行业发展前景分析及投资风险预测报告,2009.9中商情报网http://www.asdci.com.
[8]《2008年世界卫生统计》.http://www.un.org.
[9]全国孕产妇死亡监测协作组.全国孕产妇死亡监测结果分析[J].中华妇产科杂志,1999,34(11)：645-648.
[10]叶文芸.重度高危孕产妇810例分析及护理对策.解放军护理杂志.2006,23(9)：55-56.
[11]中国卫生统计年鉴.中华人民共和国卫生部编.中国协和医科大学出版社,2008,7,第一版.
[12]虞海伦.《婚姻登记条例》实施后孕产妇保健工作面临的困难和对策[J].中国妇幼保健,2008,20(20)：2625-2627.
[13]崔颖,瞿群,杨丽等.中国西部农村3岁以下儿童贫血状况分析.中国公共卫生,2008,24(9)：1052-1055.
[14]唐礼榕,郝模.我国孕产妇系统管理发展及面临的主要问题[J].中国医药指南,2005,3(4)：450-452.
[15]朱增柏,刘群,边爱玲.浅谈城镇社区妇幼保健管理[J].社区医学杂 志,2004,2(3)：36-37.
[16]吴健明,郑艺霞,洪鹏忠.建立与探索社区卫生服务妇幼卫生保健质量绩效评价体系[J].中国社区医师,2006,8(2)：97-98.
[17]周敏霞.区级妇幼保健机构生存与发展的思考和对策[J].中国农村卫生事业管理,2006,26(9)：65-66.
[18]刘利群,周小军.全国社区卫生服务机构基本情况调查分析[J].中华医院管理杂志,2003,19(8)：485-490.
[19]孟仲莹,等.城市社区妇幼保健管理工作的做法和体会[J].1998,4(13)：217-219.
[20]沈汝,刘凯波,肖殉,等.流动入口孕产妇保健及分娩调查[J].中国公共卫生,2004,20(1)：46-47.
[21]陈刚,吕军,张德英,等.流动人口妇女儿童卫生保健服务现状及对策研究概述[J].中国全科医学,2006,9(7)：541-543.
[22]高惠琦,乔磊,黄敬亨.世界卫生组织人人享有卫生保健战略的由来和发展[J].中国初级卫生保健,2004,18(8)：3-5.
[23]Carroll G, Villar J, Piaggio G, et al. WHO systematic review of randomised controlled trials of routine antenatal care [J]. Lancet,2001,357 (9628):1565-1570.
[24]Williams S, Dickson D, Forbes J, et al. An evaluation of community antenatal care[J]. Midwifery,1989,5(2):63-68.
[25]杨惠娟,沈汝,李禾等.国外社区孕产妇保健研究现状[J].实用预防医学,2008,15(3)：963-966.
[26]Roemer, MI. National Health Systems throughout the World[J]. Annu Rev Public Health,1993,14:335-353.
[27]Hedgecock J, Castro M, Cruikshank WB. Community health centers:a resource for service and training[J]. Henry Ford Hosp Med J,1992,40(1-2):45-49.
[28]DW Edington, Y Louis, Kuku Li. Recent trends in the development of the health management[J]. Health management research,2001,76(103):140-147.
[29]Dowswell T, Renfrew MJ, Gregson B, et al. A review of the literature on women's views on their maternity care in the community in the U K[J]. Midwifery, 2001,17 (3):194-202.
[30]Barnett S, Nair N, Lewycka S, Costello A. Community interventions for maternal and perinatal health[J]. BJOG,2005,112(9):1170-1173.
[31]Homer CS, Davis GK, Brodie PM. What do women feel about community-based antenatal care[J]. Aust N Z J Public Health,2000,24(6):590-595.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |