Care for the imminent miscarriage by midwives and GPs

Area of Science:

• Obstetrics and Gynecology
• General Practice
• Healthcare Management

Background:

• The Dutch College of General Practitioners developed an 'imminent miscarriage' standard to guide care.
• Understanding current practices and provider attitudes is crucial for standard optimization.

Purpose of the Study:

• To evaluate the utilization and acceptance of the 'imminent miscarriage' standard among Dutch general practitioners (GPs) and midwives.
• To identify discrepancies in clinical practice and attitudes towards specific guidelines.

Main Methods:

• A postal questionnaire was distributed to 495 GPs and 278 midwives in the Netherlands.
• The survey assessed routine management, attitudes towards 17 key guidelines, and perceived obstacles to adherence.

Main Results:

• Significant differences were observed in management approaches: midwives utilized more technology (ultrasound, doptone) and focused on post-miscarriage care, while GPs favored physical examinations.
• Commonly disregarded guidelines included the 10-day follow-up period, 6-week post-miscarriage counseling, restrictions on ultrasound use, and referral criteria after recurrent miscarriages.
• Practical challenges included patient demands for ultrasounds/referrals and obstetricians assuming control.

Conclusions:

• The study highlights variations in clinical practice and identifies specific guidelines within the 'imminent miscarriage' standard that require revision.
• Findings provide a basis for updating the standard to better align with healthcare provider practices and patient expectations.