Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands.
Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
BMC Pregnancy Childbirth. 2019 May 22;19(1):181. doi: 10.1186/s12884-019-2294-7.
Management of late-term pregnancy in midwifery- and obstetrician-led care.
Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy.
Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions.
The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units (p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001).
Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies.
助产士和妇产科医生主导的护理中的晚期妊娠管理。
由于对于晚期妊娠（≥41.0 周）的最佳管理方法尚未达成共识，因此我们探索了荷兰晚期妊娠管理中的各种管理策略，以确定这种多样性的程度以及对晚期妊娠的态度。
对所有助产士诊所（助产士主导的护理）和所有设有产科病房的医院进行了两项全国性调查，问题涉及晚期妊娠中咨询/监测的时间、频率和内容，以及引产的时间。关于晚期妊娠的建议使用李克特量表问题进行评估。
助产士主导的护理的回复率为 40%（203/511），而妇产科主导的护理的回复率为 92%（80/87）。所有产科病房都与合作的助产士诊所制定了有关晚期妊娠管理的区域协议。大多数助产士主导的护理实践（93%）会将低风险的女性至少转诊一次到妇产科医生主导的护理中进行晚期妊娠咨询。医院之间的咨询内容有所不同。与妇产科主导的护理相比，助产士主导的护理中更常进行胎膜扫刮术（90%对 31%，p<0.001）。根据 47%的助产士主导的护理实践和 83%的妇产科主导的护理单位的说法，在 41 周进行咨询应成为标准护理（p<0.001）。与妇产科主导的护理相比，在助产士主导的护理中，较少对女性进行 41.0 周的引产（3%对 21%，p<0.001）。
在荷兰，助产士和妇产科医生主导的护理中，在晚期妊娠的产前监测的时间、频率和内容以及分娩诱导的时间方面存在实质性的实践差异。基于证据的跨学科指南将有助于提高晚期妊娠管理的统一性。
