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Objective To investigate the status quo of hospital readiness of pregnant women with gestational diabetes mellitus (GDM) and analyze its main influencing factors. Methods Objective sampling method was used to select 118 pregnant women with GDM in a grade A hospital as the research object. The general information questionnaire, Readiness for Hospital Discharge Study-New Mother Form(RHDS-NMFS), Quality of Discharge Teaching Scale New Mother Form(OB-QDTS) were performed to collected data and the related factors affecting the status quo of readiness for hospital discharge were analyzed. Results The score of RHDS-NMFS of GDM women was (118. 16±18. 36) points, which was at the medium level. There were statistically significant differences in RHDS-NMFS scores of GDM women with education, other pregnancy complications or complications, mode of postpartum confinement, understanding of gestational diabetes, and whether they usually monitored blood glucose by themselves (P＜0. 05). The total score of RHDS-NMFS was positively correlated with the total score of OB-QDTS (P＜0. 05). Education level, understanding of gestational diabetes mellitus, self-monitoring of blood glucose and quality of discharge guidance were the main influencing factors of discharge preparation for GDM parturients (P＜0. 05). Conclusion Medical staff can start from the main factors affecting the discharge readiness of GDM parturients, strengthen the explanation of disease knowledge, encourage parturients to self-measure blood sugar, improve the quality of discharge guidance, and thus improve their discharge readiness. (目的 调查妊娠期糖尿病(GDM)产妇出院准备度的现状, 分析其主要影响因素。方法 采用目的抽样法选取某三甲医院的118例GDM产妇作为调查对象, 选取一般资料调查表、产妇出院准备度量表(RHDS-NMFS)、产妇出院指导质量量表(OB-QDTS)进行相关调查, 分析影响出院准备度水平的相关因素。结果 GDM产妇RHDS-NMFS量表得分为(118. 16±18. 36)分, 处于中等水平。文化程度、有无其他妊娠合并症或并发症、“坐月子”方式、对GDM的了解程度、平常是否自己监测血糖的GDM产妇出院准备度得分差异有统计学意义(P＜0. 05); RHDS-NMFS量表总分与OB-QDTS量表总分呈正相关(P＜0. 05); 文化程度、对GDM的了解程度、平常是否自己监测血糖和出院指导质量是影响GDM产妇出院准备的主要因素(P＜0. 05)。结论 医护人员可从影响GDM产妇出院准备度的主要因素着手, 加强疾病知识的讲解, 鼓励产妇自测血糖, 提高出院指导质量, 从而提高其出院准备水平。)

Abstract Background As the birth policy has been adjusted from one-child-one-couple to universal two-child-one-couple in China, there is an increasing number of women undergoing a second pregnancy after a previous cesarean section (CS). Undertaking an elective repeat CS (ERCS) has been taken for granted and has thus become a major contributor to the increasing CS rate in China. Promoting trial of labor after CS (TOLAC) can reduce the CS rate without compromising delivery outcomes. This study aimed to investigate Chinese obstetricians’ perspectives regarding TOLAC, and the factors associated with their decision-making regarding recommending TOLAC to pregnant women with a history of CS under the two-child policy. Methods A cross-sectional survey was carried out between May and July 2018. Binary logistic regression was used to determine the factors associated with the obstetricians’ intention to recommend TOLAC to pregnant women with a history of CS. The independent variables included sociodemographic factors and perceptions regarding TOLAC (selection criteria for TOLAC, basis underlying the selection criteria for TOLAC, and perceived challenges regarding promoting TOLAC). Results A total of 426 obstetricians were surveyed, with a response rate of ≥83%. The results showed that 31.0% of the obstetricians had no intention to recommend TOLAC to pregnant women with a history of CS. Their decisions were associated with the perceived lack of confidence regarding undergoing TOLAC among pregnant women with a history of CS and their families (odds ratio [OR] = 2.31; 95% CI: 1.38–1.38); obstetricians’ uncertainty about the safety of TOLAC for pregnant women with a history of CS (OR = 0.49; 95% CI: 0.27–0.96), and worries about medical lawsuits due to adverse delivery outcomes (OR = 0.14; 95% CI: 0.07–0.31). The main reported challenges regarding performing TOLAC were lack of clear guidelines for predicting or avoiding the risks associated with TOLAC (83.4%), obstetricians’ uncertainty about the safety of TOLAC for women with a history of CS (81.2%), pregnant women’s unwillingness to accept the risks associated with TOLAC (81.0%) or demand for ERCS (80.7%), and the perceived lack of confidence (77.5%) or understanding (69.7%) regarding undergoing TOLAC among pregnant women and their families. Conclusion A proportion of Chinese obstetricians did not intend to recommend TOLAC to pregnant women with a history of CS. This phenomenon was closely associated with obstetricians’ concerns about TOLAC safety and perceived attitudes of the pregnant women and their families regarding TOLAC. Effective measures are needed to help obstetricians predict and reduce the risks associated with TOLAC, clearly specify the indications for TOLAC, improve labor management, and popularize TOLAC in China. Additionally, public health education on TOLAC is necessary to improve the understanding of TOLAC among pregnant women with a history of CS and their families, and to improve their interactions with their obstetricians regarding shared decision making.