Garel M, Séguret S, Kaminski M, Cuttini M
Inserm, UMR S149, IFR69, unité de recherches épidémiologiques en santé périnatale et santé des femmes, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
Gynecol Obstet Fertil. 2007 Oct;35(10):945-50. doi: 10.1016/j.gyobfe.2007.05.022. Epub 2007 Sep 14.
Our objective was to explore the practices, attitudes and feelings of obstetricians and midwives in case of extreme prematurity.
A qualitative study was conducted as part of a European Concerted Action (EUROBS) in 1999 and 2000 in three tertiary-care maternity units, located in three cities in the northern, southern and central areas of France respectively. Semi-structured, tape-recorded interviews were conducted and were independently analysed by two different researchers using a content analysis. All full-time obstetricians and half of the full-time midwives were eligible for the study. Overall, 17 obstetricians and 30 midwives participated.
Both obstetricians and midwives considered that decision-making in case of very preterm births raised ethical problems concerning the mother and the foetus. Despite some birth weight and gestational age criteria defined in advance, management around delivery appeared to be decided on a case-by-case basis. At birth, the neonatologists made the decisions. They were perceived as more inclined than the obstetrical team to initiate intensive care. If the child was born alive, intensive care was started, knowing that it could be withdrawn later, if appropriate. Parents were sometimes involved in decision-making during pregnancy, less frequently at birth or after birth.
Compared with obstetricians, midwives tended to have a less favourable perception of the neonatologists' practices, and to deplore the lack of parental information and involvement in decision-making. Decisions about the obstetrical management and resuscitation of extremely preterm infants are essentially always made on a case-by-case basis. Parents are sometimes involved in decision-making. Midwives express serious concerns about the current practices.
我们的目的是探讨产科医生和助产士在极早产儿情况下的做法、态度和感受。
1999年和2000年，作为一项欧洲协同行动（EUROBS）的一部分，在法国北部、南部和中部三个城市的三家三级护理产科单位进行了一项定性研究。进行了半结构化的录音访谈，由两名不同的研究人员使用内容分析法进行独立分析。所有全职产科医生和一半的全职助产士符合研究条件。总体而言，17名产科医生和30名助产士参与了研究。
产科医生和助产士都认为，极早产情况下的决策引发了有关母亲和胎儿的伦理问题。尽管预先定义了一些出生体重和孕周标准，但分娩前后的管理似乎是根据具体情况决定的。出生时，新生儿科医生做出决策。他们被认为比产科团队更倾向于启动重症监护。如果孩子出生时是活的，就开始进行重症监护，同时知道如果情况合适，以后可能会停止。父母有时在孕期参与决策，在出生时或出生后参与的频率较低。
与产科医生相比，助产士对新生儿科医生的做法往往看法不太乐观，并对缺乏父母信息以及父母参与决策表示遗憾。关于极早产儿产科管理和复苏的决策基本上总是根据具体情况做出。父母有时参与决策。助产士对当前的做法表达了严重关切。
