Wilkins-Haug L, Horton J A, Cruess D F, Frigoletto F D
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Obstet Gynecol. 1996 Oct;88(4 Pt 1):483-9. doi: 10.1016/0029-7844(96)00231-1.
To examine utilization patterns of four antepartum screening tests by office-based obstetricians.
The population surveyed was the Collaborative Ambulatory Research Network, a voluntary subset of 550 ACOG fellows from 130 practices participating in data collection regarding ambulatory practices. Responses from self-administered questionnaires concerning screening for hepatitis B, gestational diabetes, neural tube defects, and trisomy 21 were analyzed.
Hepatitis screening was performed by all practices with 95% (2750 of 2886) of women tested; however, only 55% (six of 11) of at-risk newborns received treatment. For gestational diabetes screening, 94% (116 of 124) administer a 50-g glucose load to all parturients, regardless of risk factors, two-thirds initiate further testing for a 1-hour post-load glucose of 140 mg/dL or greater, and 34% do so at lower glucose levels (130-135 mg/dL). For neural tube defect screening, 92% (95 of 103) offer maternal serum alpha-fetoprotein (MSAFP) screening although when results are elevated, further recommendations are varied. For women under 35 years of age, 84% (87 of 103) offer serum screening for trisomy 21 risk, most (68%) with double or triple (MSAFP, hCG, and estriol) markers. For women over 35 years, a majority (87%) offer serum screening, although half do so only if amniocentesis is declined for age risk alone. The relatively high initial positive rate and poor specificity of serum screening were underappreciated by a large number of respondents.
Increased initial and continuing education of antenatal care providers is warranted if these screening tools are to perform optimally within office practices.
研究门诊产科医生对四项产前筛查测试的使用模式。
调查对象为协作门诊研究网络，这是一个由来自130家诊所的550名美国妇产科医师学会会员组成的自愿子集，这些会员参与了有关门诊实践的数据收集。对关于乙型肝炎、妊娠期糖尿病、神经管缺陷和21三体综合征筛查的自填问卷回复进行了分析。
所有诊所均进行了肝炎筛查，95%（2886名女性中的2750名）接受了检测；然而，只有55%（11名中的6名）高危新生儿接受了治疗。对于妊娠期糖尿病筛查，94%（124名中的116名）对所有产妇进行50克葡萄糖负荷试验，无论其风险因素如何，三分之二的人会在负荷后1小时血糖达到140毫克/分升或更高时开始进一步检测，34%的人会在血糖水平较低（130 - 135毫克/分升）时进行检测。对于神经管缺陷筛查，92%（103名中的95名）提供母血清甲胎蛋白（MSAFP）筛查，尽管结果升高时，进一步的建议各不相同。对于35岁以下的女性，84%（103名中的87名）提供21三体综合征风险的血清筛查，大多数（68%）采用双倍或三倍（MSAFP、hCG和雌三醇）标志物。对于35岁以上的女性，大多数（87%）提供血清筛查，尽管其中一半仅在因年龄风险单独拒绝羊膜穿刺术时才这样做。大量受访者并未充分认识到血清筛查相对较高的初始阳性率和较差的特异性。
如果要使这些筛查工具在门诊实践中发挥最佳效果，就需要加强对产前护理提供者的初始教育和持续教育。
