Tabor Ann, Zdravkovic Milica, Perslev Annette, Møller Lars Krag, Pedersen Beth Lilja
Department of Obstetrics and Gynecology, Hvidovre Hospital, University of Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2003 Dec;82(12):1092-8. doi: 10.1046/j.1600-0412.2003.00238.x.
To assess whether the efficacy of screening for fetal malformations is affected by patient-, staff-, team- or work environment-related factors.
A prospective cohort study was carried out at a Danish university hospital with 4000 deliveries per year. In total, 7963 fetuses were examined by midtrimester ultrasound scan during 1997 and 1998. The infants were followed up to the age of at least 1 year. The main outcome measures were the detection rate (DR) of fetal abnormalities in relation to patient factors, staff factors, team and work environment factors.
Significant malformations were detected in 100 fetuses or infants, corresponding to an incidence of 1.3%. The prenatal DR was 60%. High maternal body mass index (BMI) was associated with a lower DR, while the presence of twins, the gestational age at time of screening and the sonographer's level of experience were not. Fetuses with a prenatally undetected malformation were more often examined by more than one sonographer than fetuses without congenital malformations. Workload or monotony did not seem to affect the efficacy of screening. There was a trend towards a lower detection rate at midday and when most of the staff were at work.
Some team and work environment factors that may affect the detection rate of fetal abnormalities were identified and have been changed: appointments for screening have been reorganized, regular breaks for all the staff introduced and second opinions are given by a specialist in fetomaternal medicine. The new system will be followed up to ensure that the reorganization has not created new organizational mistakes.
评估胎儿畸形筛查的效果是否受到患者、工作人员、团队或工作环境相关因素的影响。
在一所每年有4000例分娩的丹麦大学医院进行了一项前瞻性队列研究。1997年至1998年期间，共有7963例胎儿接受了孕中期超声扫描检查。对这些婴儿进行随访至至少1岁。主要结局指标是与患者因素、工作人员因素、团队和工作环境因素相关的胎儿异常检出率（DR）。
在100例胎儿或婴儿中检测到严重畸形，发病率为1.3%。产前检出率为60%。高母体体重指数（BMI）与较低的检出率相关，而双胞胎的存在、筛查时的孕周以及超声检查人员的经验水平则与之无关。与无先天性畸形的胎儿相比，产前未检测出畸形的胎儿更常由多名超声检查人员进行检查。工作量或单调性似乎并未影响筛查效果。中午及大多数工作人员上班时存在检出率较低的趋势。
已识别出一些可能影响胎儿异常检出率的团队和工作环境因素并已做出改变：重新安排了筛查预约，为所有工作人员安排了定期休息，并由母胎医学专家提供二次诊断意见。将对新系统进行跟踪，以确保重组未产生新的组织失误。
