Fleuren M, Grol R, de Haan M, Wijkel D
Free University Hospital, Research Centre Primary/Secondary Health Care, Amsterdam, The Netherlands.
Fam Pract. 1994 Sep;11(3):275-81. doi: 10.1093/fampra/11.3.275.
A postal questionnaire was sent to a random sample of 495 Dutch general practitioners (GPs) and 278 midwives to evaluate the use of the 'imminent miscarriage' standard used by the Dutch College of General Practitioners. The response rates were 63 and 87% respectively. The first questions asked related to the respondents' routine management of an imminent miscarriage. The second part of the questionnaire addressed the respondents' attitude to the 17 most important guidelines in the standard. Finally, the respondents were invited to describe problems arising in adhering to the standard. Midwives and GPs differed in their management of an imminent miscarriage. Midwives used more 'technology' such as ultrasound scans or a doptone to trace complications or see if the fetus was still viable, whereas the GPs more often carried out vaginal and speculum examinations. Midwives also paid more attention to care following a miscarriage. The guidelines that many respondents did not adhere to involved the period of 10 days for the follow-up appointment and counselling after 6 weeks. Guidelines restricting ultrasound scans and the decision only to refer the patients to an obstetrician after three consecutive miscarriages were also not accepted by all respondents. Respondents mentioned several practical problems or obstacles in adhering to the standard, including women's requests for ultrasound scans or referrals and also the attitude of obstetricians who sometimes simply assumed control. The results will serve as a starting point for updating the standard.
向495名荷兰全科医生（GP）和278名助产士的随机样本发送了一份邮政调查问卷，以评估荷兰全科医生学院使用的“即将流产”标准的应用情况。回复率分别为63%和87%。最初的问题涉及受访者对即将流产的常规处理。问卷的第二部分涉及受访者对该标准中17条最重要指南的态度。最后，邀请受访者描述在遵守该标准过程中出现的问题。助产士和全科医生在处理即将流产的情况时存在差异。助产士更多地使用诸如超声扫描或多普勒听诊仪等“技术手段”来追踪并发症或查看胎儿是否仍有活力，而全科医生则更常进行阴道检查和窥器检查。助产士对流产后的护理也更为关注。许多受访者未遵守的指南包括随访预约的10天期限以及6周后的咨询。限制超声扫描以及仅在连续三次流产后才将患者转诊至产科医生的指南也并非被所有受访者接受。受访者提到了在遵守该标准方面的几个实际问题或障碍，包括女性对超声扫描或转诊的要求，以及产科医生有时直接接管的态度。研究结果将作为更新该标准的起点。
