Kaczorowski J, Levitt C, Hanvey L, Avard D, Chance G
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada.
Birth. 1998 Mar;25(1):11-8. doi: 10.1046/j.1523-536x.1998.00011.x.
The objective of this national survey was to describe the routine use of procedures and technologies in Canadian hospitals providing maternity care, and to determine the extent to which current use was consistent with the existing evidence and recommended guidelines for maternal and newborn care.
Representatives of 572 hospitals providing maternity care across Canada were sent questionnaires in the spring and summer of 1993; 523 (91.4%) responded. The primary outcome measures consisted of the self-reported use of obstetric procedures and technologies (perineal shaves, enemas/suppositories, intravenous infusions, initial and continuous electronic fetal heart monitoring, episiotomy rates). Hospitals were grouped according to location, size (number of live births per year), and university affiliation status.
The hospitals in the Prairie provinces, in Quebec, and in the Atlantic provinces were significantly less likely than those in Ontario to restrict their use of perineal shaves and enemas to women on admission in labor. Small hospitals were significantly more likely than large hospitals (> 1000 live births) to restrict their use of intravenous infusions, and initial and continuous electronic fetal monitoring. The university-affiliated and nonteaching hospitals were significantly less likely than the university teaching hospitals to have episiotomy rates of less than 40 percent for primiparous women. Small hospitals were more likely than large hospitals to report episiotomy rates of less than 20 percent for multiparous women.
Considerable variations occur in the routine use of obstetric procedures and technologies in Canadian hospitals providing maternity care, according to hospital location, size, and university affiliation status. Despite the existing evidence suggesting that the routine use of these practices and procedures is both unnecessary and potentially harmful, a significant number of Canadian hospitals continued to use them routinely in 1993.
这项全国性调查的目的是描述加拿大提供产科护理的医院中程序和技术的常规使用情况，并确定当前的使用情况与现有证据以及孕产妇和新生儿护理推荐指南的符合程度。
1993年春夏，向加拿大572家提供产科护理的医院的代表发送了问卷；523家（91.4%）做出了回应。主要结局指标包括自我报告的产科程序和技术的使用情况（会阴备皮、灌肠/栓剂、静脉输液、初始和持续电子胎心监护、会阴切开率）。医院根据地理位置、规模（每年活产数）和大学附属状况进行分组。
草原省份、魁北克省和大西洋省份的医院比安大略省的医院在产妇入院时将会阴备皮和灌肠的使用限制在更少的产妇身上的可能性显著更低。小型医院比大型医院（>1000例活产）更有可能限制静脉输液以及初始和持续电子胎心监护的使用。大学附属医院和非教学医院初产妇会阴切开率低于40%的可能性比大学教学医院显著更低。小型医院比大型医院更有可能报告经产妇会阴切开率低于20%。
在加拿大提供产科护理的医院中，产科程序和技术的常规使用情况根据医院地理位置、规模和大学附属状况存在很大差异。尽管现有证据表明这些做法和程序的常规使用既不必要又可能有害，但在1993年仍有相当数量的加拿大医院继续常规使用它们。
