Greenberg Mara B, Anderson Britta L, Schulkin Jay, Norton Mary E, Aziz Natali
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lucile Packard Children's Hospital at Stanford, Stanford University, 300 Pasteur Drive HH333, Stanford, CA 94305, USA.
Infect Dis Obstet Gynecol. 2012;2012:628362. doi: 10.1155/2012/628362. Epub 2012 Dec 23.
Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.
目的。研究美国产科医生诊断和治疗绒毛膜羊膜炎的实践模式。研究设计。我们向美国妇产科医师学会成员发放了一份基于邮件的调查问卷，询问人口统计学、执业环境和绒毛膜羊膜炎管理策略。我们进行了单变量和多变量分析。结果。在发放的500份调查问卷中，53.8%被收回，212份符合研究标准并进行了分析。大多数受访者从事团体执业（66.0%），每年接生超过100例（60.0%），执业超过10年（77.3%），且在非大学环境中工作（85.1%）。体温加上一项额外标准（61.3%）是最常见的诊断策略。报告了超过25种不同的一线抗生素治疗方案，其中30.0%的受访者使用单一药物。产后抗生素使用时长差异很大，从无产后治疗（阴道分娩后为34.5%，剖宫产术后为11.3%）到产后治疗48小时（阴道分娩后为24.7%，剖宫产术后为32.1%）。在多变量分析中，没有任何从业者特征与诊断或治疗策略独立相关。结论。当前绒毛膜羊膜炎管理的临床实践存在很大差异。这可能表明缺乏一级证据。未来的前瞻性临床试验可能会为绒毛膜羊膜炎的诊断和治疗提供更多基于证据的实践建议。
