Britton J R
Division of Neonatology, University of Utah Medical Center, Salt Lake City 84132, USA.
Birth. 1998 Sep;25(3):161-8. doi: 10.1046/j.1523-536x.1998.00161.x.
Although official guidelines and recent legislation have addressed early postpartum hospital discharge and follow-up, little is known about the practices of obstetricians in Canada and the United States on this issue.
Questionnaires were mailed to two separate random samples of 2000 Fellows of the American College of Obstetricians and Gynecologists (ACOG) in the United States and all Canadian Fellows. Practices and perceptions were compared with those recommended in the literature, recent legislation, and guidelines of ACOG and American Academy of Pediatrics (AAP).
In contrast to concerns expressed in the medical literature and official AAP/ACOG guidelines, many physicians considered potential psychosocial and demographic risk factors relatively unimportant in making early discharge decisions, preferring to emphasize aspects of the patient's medical condition, hospital course, and social support. Although the official guidelines encourage follow-up for all patients discharged early, additional visits are routinely advised by only 39 percent of obstetricians after vaginal delivery and by 68 percent after cesarean section. After vaginal delivery 39 percent of obstetricians used telephone follow-up and 37 percent after cesarean delivery. Moreover, although the official guidelines recommend follow-up within 48 hours of discharge, only one-half of the obstetricians surveyed advised follow-up at this time. In contrast to the guidelines, most obstetricians defined early discharge as that occurring within 24 hours after vaginal delivery and 72 hours after cesarean delivery; most defined optimal lengths of stay within the 48-hour (after vaginal delivery) and 96-hour (after cesarean delivery) periods considered short by the guidelines.
Current postpartum early discharge and follow-up practices emphasize the physical health of the mother and place little emphasis on social risk. They appear to be influenced by perceptions of the appropriateness of the length of stay and are not in agreement with professional guidelines.
尽管官方指南和近期立法已涉及产后早期出院及随访问题，但对于加拿大和美国产科医生在该问题上的做法却知之甚少。
向美国2000名美国妇产科医师学会（ACOG）会员的两个独立随机样本以及所有加拿大会员邮寄了调查问卷。将他们的做法和看法与文献、近期立法以及ACOG和美国儿科学会（AAP）指南中推荐的做法和看法进行了比较。
与医学文献及AAP/ACOG官方指南中表达的担忧相反，许多医生认为在做出早期出院决定时，潜在的心理社会和人口统计学风险因素相对不重要，他们更倾向于强调患者的身体状况、住院过程和社会支持等方面。尽管官方指南鼓励对所有早期出院的患者进行随访，但只有39%的产科医生在阴道分娩后常规建议进行额外随访，剖宫产术后这一比例为68%。阴道分娩后，39%的产科医生采用电话随访，剖宫产术后这一比例为37%。此外，尽管官方指南建议在出院后48小时内进行随访，但接受调查的产科医生中只有一半建议此时进行随访。与指南不同的是，大多数产科医生将早期出院定义为阴道分娩后24小时内和剖宫产术后72小时内；大多数人将最佳住院时长定义在指南认为较短的48小时（阴道分娩后）和96小时（剖宫产术后）时间段内。
当前产后早期出院及随访做法强调母亲的身体健康，而对社会风险关注较少。它们似乎受到对住院时长适当性认知的影响，与专业指南不一致。
