Understanding if, How, and Why Women with Prior Spontaneous Preterm Births are Treated with Progestogens: A National Survey of Obstetrician Practice Patterns.
Understanding if, How, and Why Women with Prior Spontaneous Preterm Births are Treated with Progestogens: A National Survey of Obstetrician Practice Patterns.
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了解先前自然早产的妇女是否、如何以及为何接受孕激素治疗：全国产科医生实践模式调查。
DOI：
10.1055/s-0038-1675556
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发表时间：
2018
期刊：
影响因子：
0.9
通讯作者：
Carroll,Susan
中科院分区：
文献类型：
--
作者：
Gallagher,JackR;Gudeman,Jennifer;Heap,Kylee;Vink,Joy;Carroll,Susan
目的2017年，母胎医学学会指南委员会重申17-羟孕酮己酸酯(17-α-羟孕酮己酸酯)预防早产的作用未得到充分利用。我们试图确定是什么驱使产科医生选择孕激素治疗，这些产科医生管理着有1+单胎自发性PTB病史(37周)的孕妇，然后在过去12个月内分娩单胎妊娠。在被联系的423名符合研究条件的医生中，358名(85%)参与了研究，56名(16%)孕产妇胎儿医学专家和302名(84%)普通产科/妇科医生(OB/GYN)从991份合格的患者图表中提取了数据。结果近四分之三的患者(73.6%)接受了17-OHPC治疗，18.6%的患者接受了阴道孕酮治疗，11.8%的患者没有接受治疗。医生选择(1)处方品牌17-OHPC的关键驱动因素是“FDA(食品和药物管理局)批准”(52%相对影响[RI])和“SMFM指南”(24%RI)；(2)开阴道孕酮是“易于给药”(32%RI)和“缩短宫颈”(16%RI)；以及(3)不提供预防措施是“患者不了解风险”(35%RI)和“没有缩短宫颈”(29%RI)。结论研究结果支持SMFM关于17-OHPC持续利用不足以预防肺结核的论点。需要进行额外的医生教育评估，并采取适当的后续行动。
ObjectiveIn 2017, the Society for Maternal-Fetal Medicine (SMFM) Guideline Committee reaffirmed that 17α-hydroxyprogesterone caproate (17-OHPC) to prevent preterm birth (PTB) is underutilized. We sought to determine what drove progestogen treatment choice of obstetricians managing pregnant women with histories of 1+ singleton spontaneous PTBs (< 37 weeks) who then delivered singleton gestations within the previous 12 months.SubjectsWe recruited a nationally representative random sample of obstetricians to abstract medical records of study-qualified patients. Of the 423 study-qualified physicians contacted, 358 (85%) participated; 56 (16%) maternal fetal medicine specialists and 302 (84%) general obstetrician/gynecologists (OB/GYNs) extracted data from 991 eligible patient charts.ResultsAlmost three-fourths of patients (73.6%) were treated with 17-OHPC; 18.6% received vaginal progesterone, and 11.8% were not treated. Key drivers of physicians' choice to (1) prescribe branded 17-OHPC were “FDA (Food and Drug Administration) approval” (52% relative influence [RI]) and “SMFM guidelines” (24% RI); (2) prescribe vaginal progesterone were “ease of administration” (32% RI) and “shortened cervix” (16% RI); and (3) not provide prophylaxis were “patient not informed of risk” (35% RI) and “no shortened cervix” (29% RI).ConclusionStudy findings support SMFM's contention of continued 17-OHPC underutilization to prevent PTB. Need for additional physician education merits assessment along with appropriate follow-up actions.