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减重手术后的妊娠:产科医生舒适度、知识及实践模式的全国性调查

Pregnancy After Bariatric Surgery: National Survey of Obstetrician's Comfort, Knowledge, and Practice Patterns.

作者信息

Smid Marcela C, Dotters-Katz Sarah K, Mcelwain Cora-Ann, Volckmann Eric T, Schulkin Jay, Stuebe Alison M

机构信息

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, 50 North Medical Drive, Suite 2B200, Salt Lake City, UT, 84132, USA.

出版信息

Obes Surg. 2017 Sep;27(9):2354-2359. doi: 10.1007/s11695-017-2661-2.

Abstract

OBJECTIVE

The objective of this study is to survey a nationally representative sample of obstetricians regarding comfort, knowledge, and practice patterns of caring for pregnant women after bariatric surgery.

MATERIALS AND METHODS

We conducted an online survey of US obstetricians and describe obstetrician's demographics, practice settings, and practice patterns. We assessed respondent's knowledge and recommended practices. We compared provider knowledge by years since completing residency, scope of practice (generalist or specialist), and practice setting (academic setting or other). Statistical significance was set at p < 0.05.

RESULTS

A total of 106 completed the survey (response rate of 54%). Respondents had a median age of 47 and median 17 years in practice. Sixty-two percent were generalists. Nearly all of the respondents (94%) had some experience with caring for pregnant women after bariatric surgery and 83% reported feeling "very comfortable" (48%) or "somewhat comfortable" (35%) providing care for this population. Most (74%) were aware of increased risk of small for gestational age after surgery. Only 13% were able to correctly identify all recommended nutritional labs and 20% reported that they "did not know" which labs are recommended. There were no differences in comfort, experience, knowledge, and practice patterns by physician characteristics and practice settings.

CONCLUSION

While most obstetricians are aware of perinatal risks after bariatric surgery, a substantial percentage of obstetricians are unaware of recommended practices regarding nutrition and nutritional monitoring. As bariatric surgery becomes increasingly prevalent among reproductive age women, educational interventions to increase obstetricians' knowledge of optimal care of pregnant women after bariatric surgery are urgently needed.

摘要

目的

本研究的目的是对全国具有代表性的产科医生样本进行调查,了解其在肥胖症手术后照顾孕妇时的舒适度、知识水平和实践模式。

材料与方法

我们对美国产科医生进行了一项在线调查,并描述了产科医生的人口统计学特征、执业环境和实践模式。我们评估了受访者的知识水平和推荐的实践方法。我们根据完成住院医师培训后的年限、执业范围(全科医生或专科医生)以及执业环境(学术环境或其他)对医生的知识水平进行了比较。统计学显著性设定为p < 0.05。

结果

共有106人完成了调查(回复率为54%)。受访者的年龄中位数为47岁,执业年限中位数为17年。62%为全科医生。几乎所有受访者(94%)都有照顾肥胖症手术后孕妇的经验,83%的受访者表示在为这一人群提供护理时感到“非常舒适”(48%)或“有些舒适”(35%)。大多数人(74%)意识到手术后胎儿生长受限风险增加。只有13%的人能够正确识别所有推荐的营养实验室检查项目,20%的人表示他们“不知道”推荐哪些实验室检查项目。医生特征和执业环境在舒适度、经验、知识水平和实践模式方面没有差异。

结论

虽然大多数产科医生意识到肥胖症手术后的围产期风险,但仍有相当比例的产科医生不了解关于营养和营养监测的推荐实践方法。随着肥胖症手术在育龄妇女中越来越普遍,迫切需要开展教育干预措施,以提高产科医生对肥胖症手术后孕妇最佳护理的认识。

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