预防性剖宫产：罗马尼亚产科的现实与推荐的医疗保健改进。
Defensive caesarean section: A reality and a recommended health care improvement for Romanian obstetrics.
机构信息
Department of Obstetrics and Gynecology "St Pantelimon" Clinical Emergency Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.
Complementary Sciences, Medical Informatics and Biostatistics Discipline, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
出版信息
J Eval Clin Pract. 2019 Feb;25(1):111-116. doi: 10.1111/jep.13025. Epub 2018 Sep 4.
RATIONALE
Defensive caesarean section (CS) has become one of the most common medical procedure worldwide. Additionally, performing CS in accordance with the patient's choice is an appropriate professional practice.
AIMS AND OBJECTIVE
This paper reports a prospective, observational, multicenter study to quantify the use of this type of practice that is performed by obstetricians to avoid medico-legal complaints and decrease the frequency of malpractice litigations.
METHODS
We interviewed 73 obstetricians from three distinct units of obstetrics and gynaecology, to assess their opinion regarding defensive caesarean delivery and caesarean delivery performed upon maternal request. We conducted an opinion-based survey using questionnaires based on nine, close-ended questions.
RESULTS
Out of 73 respondents, 51 (69.9%) stated that they perform defensive CS; 63 (86.3%) declared that their choice of birth delivery is influenced by the risk of being accused of malpractice; 60 (82.2%) indicated that it is normal for the patient to be able to decide on the type of delivery; and 63 (86.3%) declared that they consult their patients regarding their delivery preferences. We found statistically significant differences between the respondents who declare that they perform defensive CS (69.9%) and those who said that they are influenced by the risk of malpractice when they choose the method of delivery for their patients (86.3%) (P < .001; McNemar Test).
CONCLUSIONS
The results of our study indicate that defensive caesarean section is a widespread practice among obstetrics practitioners in Romania.
背景
防御性剖宫产术（CS）已成为全球最常见的医疗程序之一。此外，根据患者的选择进行 CS 是一种适当的专业实践。
目的和目标
本研究报告了一项前瞻性、观察性、多中心研究，旨在量化这种做法的使用频率，这种做法是由产科医生为了避免医疗法律投诉和减少医疗事故诉讼而进行的。
方法
我们采访了来自三个不同妇产科单位的 73 名产科医生，以评估他们对防御性剖宫产和因产妇要求而进行的剖宫产的看法。我们使用基于九个封闭式问题的问卷进行了基于意见的调查。
结果
在 73 名受访者中，有 51 名（69.9%）表示他们进行防御性 CS；63 名（86.3%）表示他们选择分娩方式受到被指控医疗事故的风险的影响；60 名（82.2%）表示患者有权决定分娩方式是正常的；63 名（86.3%）表示他们与患者讨论了他们的分娩偏好。我们发现，声称进行防御性 CS 的受访者（69.9%）和表示他们在为患者选择分娩方式时受到医疗事故风险影响的受访者（86.3%）之间存在统计学上的显著差异（P<.001；McNemar 检验）。
结论
我们的研究结果表明，防御性剖宫产术在罗马尼亚的产科医生中是一种普遍的做法。
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