本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2676

摘要内容如下：

背景

美国严重的孕产妇发病率和死亡率比所有类似国家都要严重，对黑人妇女的影响最大。新出现的研究表明，分娩过程中不尊重他人的护理导致了这一问题。

目的

对尊重产妇护理（RMC）的定义和有效措施、其对改善孕妇和产后母婴健康结果的有效性以及实施策略进行系统审查。

数据源

系统检索Ovid MEDLINE、CINAHL、EMBASE、Cochrane Central Register of Controlled Trials、PSYCINFO和SOCINDEX for English-Language Studies（开始至2023年7月）。

研究选择

RMC与常规护理干预有效性研究的随机对照和非随机对照试验定义和测量研究的其他定性和非比较验证研究。

数据提取

使用已建立的方法进行双重数据提取和质量评估，通过共识解决分歧。

数据综合

在所有问题中纳入了37项研究，其中1项提供的证据不足以证明RMC改善孕产妇结局的有效性，没有一项研究RMC改善婴儿结局。为了定义RMC，作者确定了12个RMC框架，其中确定了2个主要概念：不尊重和虐待以及基于权利的框架。不尊重和虐待部分侧重于确认出生虐待；基于权利的框架纳入了生殖正义、人权和反种族主义的各个方面。五个重叠的框架主题包括免受虐待、同意、隐私、尊严、沟通、安全和正义。在内容效度、结构效度和内部一致性方面，12种测量RMC的工具在24项研究中得到了验证，但缺乏金标准，限制了对效标效度的评估。三个专门用于RMC的工具至少有一项研究证明了内部一致性和与美国环境相关的预期结构，但没有一个工具是RMC的最佳衡量标准。

局限性

没有研究评估其他健康结果或RMC实施策略。缺乏RMC工具的定义和黄金标准极限评估。

结论

RMC的框架描述得很好，但定义各不相同。衡量RMC的工具表现出一致性，但缺乏黄金标准，需要在美国环境中实施之前进行进一步评估。实施RMC以改善任何孕产妇或婴儿健康结果的有效性缺乏证据。

英文原文如下：

Abstracts

BACKGROUND  Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests that disrespectful care during childbirth contributes to this problem.

PURPOSE  To conduct a systematic review on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving maternal and infant health outcomes for those who are pregnant and postpartum, and strategies for implementation.

DATA SOURCES  Systematic searches of Ovid Medline, CINAHL, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and SocINDEX for English-language studies (inception to July 2023).

STUDY SELECTION  Randomized controlled trials and nonrandomized studies of interventions of RMC versus usual care for effectiveness studies; additional qualitative and noncomparative validation studies for definitions and measurement studies.

DATA EXTRACTION  Dual data abstraction and quality assessment using established methods, with resolution of disagreements through consensus.

DATA SYNTHESIS  Thirty-seven studies were included across all questions, of which 1 provided insufficient evidence on the effectiveness of RMC to improve maternal outcomes and none studied RMC to improve infant outcomes. To define RMC, authors identified 12 RMC frameworks, from which 2 main concepts were identified: disrespect and abuse and rights-based frameworks. Disrespect and abuse components focused on recognizing birth mistreatment; rights-based frameworks incorporated aspects of reproductive justice, human rights, and antiracism. Five overlapping framework themes include freedom from abuse, consent, privacy, dignity, communication, safety, and justice. Twelve tools to measure RMC were validated in 24 studies on content validity, construct validity, and internal consistency, but lack of a gold standard limited evaluation of criterion validity. Three tools specific for RMC had at least 1 study demonstrating consistency internally and with an intended construct relevant to U.S. settings, but no single tool stands out as the best measure of RMC.

LIMITATIONS  No studies evaluated other health outcomes or RMC implementation strategies. The lack of definition and gold standard limit evaluation of RMC tools.

CONCLUSION  Frameworks for RMC are well described but vary in their definitions. Tools to measure RMC demonstrate consistency but lack a gold standard, requiring further evaluation before implementation in U.S. settings. Evidence is lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome.

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