确定临床实践和基于证据的指南之间的差异在重复性妊娠损失护理中,这是临床指南实施的工具
A Youssef1, E E L O Lashley2, N Vermeulen3
1Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands. a.youssef@lumc.nl.
BMC pregnancy and childbirth
|July 28, 2023
概括
荷兰的重复性妊娠损失 (RPL) 护理显示出显著的实践差异. 许多临床医生偏离欧洲人类生殖和胚胎学会 (ESHRE) 的指导方针,需要有针对性的实施策略来改善患者护理.
科学领域:
- 生殖医学 生殖医学
- 临床实践指南 临床实践指南
- 产科和妇科 产科和妇科
背景情况:
- 在复发性妊娠损失 (RPL) 护理中的实践变化很普遍.
- 对于RPL管理的国际指导方针有所不同,可能会增加跨境生殖护理.
- 荷兰的RPL指南正在根据欧洲人类生殖和胚胎学会 (ESHRE) 的指南进行更新.
研究的目的:
- 为了确定现有的RPL指南与荷兰当前的临床实践之间的差异.
- 为改善RPL护理的新指南和实施策略的制定提供信息.
主要方法:
- 在荷兰所有107家医院分娩和妇科实践中进行了全国性调查.
- 一个由36个问题组成的问卷涵盖了临床医生人口统计,RPL定义,调查和治疗.
- 数据与荷兰国家和ESHRE指南进行了比较.
主要成果:
- 所有实践都参与了;大多数人将RPL定义为两个或更多的怀孕损失.
- 超过一半的人进行了血栓友爱查 (ESHRE不建议),而像抗脂综合征 (APS) 调查等推测试的频率较低.
- 在没有风险评估的情况下进行了20%的家长型鉴定,尽管缺乏指导方针建议,但遗传性血栓友病或不明原因的RPL的治疗经常被处方.
结论:
- 荷兰的RPL实践存在相当大的差异,尽管遵守了一些ESHRE建议.
- 发现的差异突显出需要多方面的实施策略,包括教育和审计.
- 提高准则的遵守率可以提高RPL患者的护理质量,并减少跨境护理的需要.
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