Practice variation of test procedures reportedly used in routine antenatal care in The Netherlands
Practice variation of test procedures reportedly used in routine antenatal care in The Netherlands
复制标题
据报道，荷兰常规产前护理中使用的测试程序的实践变化
DOI：
10.1034/j.1600-0412.1999.780107.x
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发表时间：
1999
影响因子：
4.3
通讯作者：
P. J. van der Maas
中科院分区：
文献类型：
--
作者：
H. Wildschut;P. T. Hoope;M. Borkent‐Polet;Heleen Traas;H. V. van Agt;M. D. de Kroon;P. J. van der Maas
背景
鼓励孕妇预约产前护理。然而，人们对产前护理的内容知之甚少，尤其是各种检查程序。本描述性研究的目的是评估荷兰产前护理标准测试程序的变化。
方法
在荷兰的专业产科医生和助产士中进行了一项全国性的邮寄问卷调查。邀请在荷兰妇产科学会注册的每个产科诊所的代表（n = 132）和在荷兰助产士协会注册的助产士样本（n = 394）报告其所在环境中常规用于产前护理的标准测试政策。此外，他们还被要求报告他们对产前保健计划对妊娠结局的潜在影响的看法。
结果
105 名专业产科医生 (80%) 和 281 名助产士 (71%) 提供了完整信息。据报道，产妇血压和体重的评估是产前期间最常见的常规程序。然而，每个行业内报告的异常结果的定义和含义存在显着差异，特别是在妊娠期高血压疾病的识别和管理领域。对宫颈进行系列检查并不是这两个群体的标准政策。关于实验室检测，报告了相当大的专业内和专业间差异，特别是母亲血清葡萄糖、风疹抗体滴度以及葡萄糖和蛋白质尿试纸的差异。至于标准超声政策，我们注意到专业内和专业间的广泛差异。 72 名专业产科医生 (68%) 和 92 名助产士 (33%) 经常通过超声波估算孕妇的妊娠持续时间 (p<0.001)。 31 名专业产科医生 (30%) 和 44 名助产士 (16%) 定期为孕妇在妊娠 18-20 周时进行胎儿异常扫描（p<0.01）；据报道，29 名产科医生 (28%) 和 11 名助产士 (4%) 对所有孕妇使用超声波来检测胎儿生长受限 (p<0.001)。总体而言，助产士对产前护理对妊娠结局的影响的看法比产科医生更为乐观。
结论
尽管荷兰专业产科医生和助产士提供的标准产前护理方案似乎相对统一，但在以下方面存在广泛的专业内和专业间差异：(1) 根据建议对部分或全部孕妇进行检测的应用；(2) 定义正常与异常；(3) 异常结果的潜在影响。
BACKGROUND
Pregnant women are encouraged to book for antenatal care. However, little is known about the contents of antenatal care, in particular regarding various test procedures. The present descriptive study was conducted to assess the variation in standard test procedures in antenatal care in The Netherlands.
METHODS
A nationwide structured survey by mailed questionnaire was carried out among specialist obstetricians and midwives in The Netherlands. Representatives of each obstetric practice registered with the Dutch Society of Obstetrics and Gynecology (n=132) and a sample of midwives registered with the Dutch Society of Midwives (n=394) were invited to report the standard policy of tests routinely used for antenatal care in their own setting. Furthermore, they were asked to report their views on the potential impact of the antenatal care program on pregnancy outcome.
RESULTS
Complete information was available from 105 specialist obstetricians (80%) and 281 midwives (71%). The assessment of maternal blood pressure and weight are reportedly the commonest procedures routinely conducted during the antenatal period. However, within each profession reported definitions and implications of abnormal findings vary markedly, especially in the fields of identification and management of hypertensive disorders in pregnancy. Serial examination of the cervix is not standard policy among both groups. With respect to laboratory tests, considerable intra- and interprofessional variations are reported, in particular those for maternal serum glucose, rubella antibody titer and urinary dipstick for glucose and protein. As to standard ultrasound policies, wide intra- and interprofessional variations are noted. Seventy-two specialist obstetricians (68%) and 92 midwives (33%) routinely estimate the duration of gestation by ultrasound in pregnant women (p<0.001). A fetal anomaly scan at about 18-20 weeks' gestation is routinely offered to pregnant women by 31 specialist obstetricians (30%) and 44 midwives (16%) (p<0.01); 29 obstetricians (28%) and 11 midwives (4%) reportedly use ultrasound in all pregnant women for the detection of fetal growth restriction (p<0.001). Overall, midwives have a more optimistic view about the impact of antenatal care on pregnancy outcome than obstetricians.
CONCLUSIONS
Although the standard package of antenatal care provided by both specialist obstetricians and midwives in The Netherlands seems to be relatively uniform, wide intra- and interprofessional variations exist with respect to (1) the application of tests in terms of recommendations to test some or all pregnant women, (2) defining normal from abnormal and (3) potential implications of abnormal findings.