Verschoor Marianne A C, Lemmers Marike, Wekker Malu Z, Huirne Judith A F, Goddijn Mariëtte, Mol Ben Willem J, Ankum Willem M
Department of Obstetrics and Gynecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands.
Department of Obstetrics and Gynecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands ; Department of Obstetrics and Gynaecology, Flevo Hospital, P.O. Box 3005, 1300 EG Almere, The Netherlands.
Obstet Gynecol Int. 2014;2014:387860. doi: 10.1155/2014/387860. Epub 2014 Nov 4.
Objectives. To survey practice variation in the management of first trimester miscarriage in The Netherlands. Methods. We sent an online questionnaire to gynecologists in eight academic, 37 nonacademic teaching, and 47 nonteaching hospitals. Main outcome measures were availability of a local protocol; estimated number of patients treated with curettage, misoprostol, or expectant management; misoprostol regimen; and estimated number of curettages performed after initial misoprostol treatment. Outcomes were compared to the results of a previous nationwide survey. Results. The response rate was 100%. A miscarriage protocol was present in all academic hospitals, 68% of nonacademic teaching hospitals, and 38% of nonteaching hospitals (P = 0.008). Misoprostol was first-choice treatment for 41% of patients in academic hospitals versus 34% and 27% in teaching-and nonteaching hospitals (P = 0.045). There were 23 different misoprostol regimens. Curettage was first-choice treatment in 29% of patients in academic hospitals versus 46% and 50% in nonacademic teaching or nonteaching hospitals (P = 0.007). In 30% of patients, initial misoprostol treatment was followed by curettage. Conclusions. Although the percentage of gynaecologists who are aware of the availability of misoprostol for miscarriage treatment has doubled to almost 100% since 2005, practice variation is still large. This practice variation underlines the need for a national guideline.
目的。调查荷兰孕早期流产管理中的实践差异。方法。我们向八所学术医院、37所非学术教学医院和47所非教学医院的妇科医生发送了一份在线问卷。主要观察指标为当地方案的可用性；估计接受刮宫术、米索前列醇或期待治疗的患者数量；米索前列醇治疗方案；以及初始米索前列醇治疗后进行刮宫术的估计数量。将结果与之前全国性调查的结果进行比较。结果。回复率为100%。所有学术医院、68%的非学术教学医院和38%的非教学医院都有流产方案（P = 0.008）。在学术医院，41%的患者首选米索前列醇治疗，而在教学医院和非教学医院这一比例分别为34%和27%（P = 0.045）。有23种不同的米索前列醇治疗方案。在学术医院，29%的患者首选刮宫术，而在非学术教学医院或非教学医院这一比例分别为46%和50%（P = 0.007）。30%的患者在初始米索前列醇治疗后进行了刮宫术。结论。尽管自2005年以来，知晓米索前列醇可用于流产治疗的妇科医生比例已翻倍至近100%，但实践差异仍然很大。这种实践差异凸显了制定全国性指南的必要性。
