A survey of access to trial of labor in California hospitals in 2012.
A survey of access to trial of labor in California hospitals in 2012.
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DOI：
10.1186/1471-2393-13-83
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发表时间：
2013-04-03
影响因子：
3.1
通讯作者：
Gates E
中科院分区：
文献类型：
--
作者：
Barger MK;Dunn JT;Bearman S;DeLain M;Gates E
2010年，NIH和ACOG建议增加妇女剖宫产后试产的机会(TOLAC)。这项研究探讨了加州TOLAC的接入情况、自2007年和2010年以来接入情况的变化，以及TOLAC和非TOLAC医院的特点。在2011年11月至2012年6月期间，对加州所有平民产科医院的主管护士进行了调查，了解医院TOLAC的可用性和对提供者的要求。VBAC率从加州全州卫生规划和发展办公室(OSHPD)获得。医院之间的距离使用OSHPD地理编码计算。所有243家被联系的产科医院都参与了调查。2010年，在56%的TOLAC医院中，TOLAC医院VBAC的中位数为10.8%(范围为0-37.3%)。VBAC发生率低的最主要原因是医生不愿进行VBAC，特别是因为要求在分娩期间持续在场。TOLAC医院更有可能是城市社区中接受产科住院医师培训的较大医院。然而，在非TOLAC医院有6个(11.3%)住院项目，有5个(13.5%)乡村医院提供TOLAC。大多数TOLAC医院有全天候的麻醉覆盖，如果TOLAC患者入院，要求产科医生持续在场；17家(12.2%)允许人员在15-30分钟路程。TOLAC的合格标准包括一次剖宫产(32.4%)、自然分娩(52.5%)、持续胎儿监护和静脉留置(99.3%)、硬膜外镇痛(19.4%)。从非TOLAC到TOLAC医院的平均距离为37英里。其中25%的非TOLAC医院超过51英里。从最近的TOLAC医院。2012年，139家医院(57.2%)提供TOLAC，比2007年减少16.6%。自2010年以来，有五家医院开始提供TOLAC，四家医院停止提供TOLAC，净收益为一家医院提供TOLAC，另有三家医院正在考虑提供TOLAC。只有两家医院将ACOG指南的变化作为这一变化的一个原因。尽管2010年NIH和ACOG建议鼓励更多地使用TOLAC，但44%的加州医院不允许使用TOLAC。在允许TOLAC的56%的人中，10.8%的人报告VBAC出生不到3%。因此，鼓励更多地使用TOLAC的国家建议在加利福尼亚州收效甚微。
In 2010, the NIH and ACOG recommended increasing women’s access to trial of labor after cesarean (TOLAC). This study explored access to TOLAC in California, change in access since 2007 and 2010, and characteristics of TOLAC and non-TOLAC hospitals. Between November 2011 and June 2012, charge nurses at all civilian California birth hospitals were surveyed about hospitals’ TOLAC availability and requirements for providers. VBAC rates were obtained from the California Office of Statewide Health Planning and Development (OSHPD). Distance between hospitals was calculated using OSHPD geocoding. All 243 birth hospitals that were contacted participated. In 2010, among the 56% TOLAC hospitals, the median VBAC rate among TOLAC hospitals was 10.8% (range 0-37.3%). The most cited reason for low VBAC rates was physician unwillingness to perform them, especially due to the requirement to be continually present during labor. TOLAC hospitals were more likely to be larger hospitals in urban communities with obstetrical residency training. However, there were six (11.3%) residency programs in non-TOLAC hospitals and 5 (13.5%) rural hospitals offering TOLAC. The majority of TOLAC hospitals had 24/7 anesthesia coverage and required the obstetrician to be continually present if a TOLAC patient was admitted; 17 (12.2%) allowed personnel to be 15-30 minutes away. TOLAC eligibility criteria included one prior cesarean (32.4%), spontaneous labor (52.5%), continuous fetal monitoring and intravenous access (99.3%), and epidural analgesia (19.4%). The mean distance from a non-TOLAC to a TOLAC hospital was 37 mi. with 25% of non-TOLAC hospitals more than 51 mi. from the closest TOLAC hospital. In 2012, 139 hospitals (57.2%) offered TOLAC, 16.6% fewer than in 2007. Since 2010, five hospitals started and four stopped offering TOLAC, a net gain of one hospital offering TOLAC with three more considering it. Only two hospitals cited change in ACOG guidelines as a reason for the change. Despite the 2010 NIH and ACOG recommendations encouraging greater access to TOLAC, 44% of California hospitals do not allow TOLAC. Of the 56% allowing TOLAC, 10.8% report fewer than 3% VBAC births. Thus, national recommendations encouraging greater access to TOLAC had a minor effect in California.
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影响因子：
158.5
作者：
McMahon, MJ;Luther, ER;Olshan, AF
通讯作者：
Olshan, AF
影响因子：
4.4
作者：
Zweifler, J;Garza, A;Lau, M
通讯作者：
Lau, M
影响因子：
9.8
作者：
Macones, GA;Peipert, J;Ratcliffe, SJ
通讯作者：
Ratcliffe, SJ
影响因子：
7.2
作者：
Coassolo, KM;Stamilio, DM;Macones, GA
通讯作者：
Macones, GA
影响因子：
7.2
作者：
Guise, Jeanne-Marie;Denman, Mary Anna;McDonagh, Marian
通讯作者：
McDonagh, Marian