背景:反复妊娠丢失(RPL)护理的实践差异很常见。国际准则对RPL夫妇管理的建议各不相同,这可能导致跨境生殖护理的增加。目前,荷兰RPL指南改编自欧洲人类生殖和胚胎学学会(ESHRE)指南.我们的目标是确定RPL指南和RPL实践之间的差异。在制定新的准则和执行战略以促进遵守新建议时,可以考虑这些差异。
方法:在荷兰的所有107家医院妇产科实践中进行了一项关于RPL患者管理的全国性调查。这项调查是通过荷兰妇产科医师协会发送给所有附属临床医师的。问卷由36个问题组成,分为四个部分:临床医生的人口统计学,RPL定义,调查和治疗。将数据与荷兰国家指南和ESHRE最新指南给出的建议进行比较。
结果:所有以医院为基础的实践(100%;n=107)都填写了在线问卷。大多数受访者对RPL的定义类似,作为两个或两个以上的妊娠损失(87.4%),非强制性连续(93.1%)。超过一半的受访者常规进行血栓性筛查(58%),尽管ESHRE没有建议,而甲状腺功能(57%),在抗磷脂综合征(APS)的情况下,甲状腺自身免疫(27%)和β2-糖蛋白抗体(42%)被推荐,但研究频率较低.关于父母的核型分析,20%的受访者表示他们总是进行父母核型分析,没有事先的风险评估。因为RPL。经常开处方治疗遗传性血栓形成(43.8%(n=137)),尽管不推荐。最后,相当一部分(12-16%)的受访者在无法解释的RPL的情况下开药。
结论:虽然许多临床医生进行ESHRE建议的调查,荷兰的RPL实践有相当大的差异。我们发现了RPL指南和RPL实践之间的差异,提供专注于多方面实施战略的可能性,比如教育干预,本地共识流程以及审核和反馈。这将提高为RPL患者提供的护理质量,并可能减少患者转向多种意见或跨境生殖护理的必要性。
BACKGROUND: Practice variation in recurrent pregnancy loss (RPL) care is common. International guidelines vary in their recommendations for the management of RPL couples, which could lead to an increase of cross border reproductive care. Currently, the Dutch RPL guideline is being adapted from the European Society for Human Reproduction and Embryology (ESHRE)
guideline. We aim to identify discrepancies between RPL
guidelines and RPL practice. These discrepancies could be considered in the development of a new guideline and implementation strategies to promote adherence to new recommendations.
METHODS: A nationwide survey on the management of RPL patients was conducted across all 107 hospital-based obstetrics and gynaecology practices in the Netherlands. The survey was sent via the Dutch Society for Obstetricians and Gynaecologists to all affiliated clinicians. The questionnaire consisted of 36 questions divided in four sections: clinician\'s demographics, RPL definition, investigations and therapy. The data were compared to the recommendations given by the Dutch national guideline and the most recent
guideline of the ESHRE.
RESULTS: All hospital-based practices (100%; n = 107) filled in the online questionnaire. The majority of respondents defined RPL similarly, as two or more pregnancy losses (87.4%), not obligatory consecutive (93.1%). More than half of respondents routinely perform thrombophilia screening ( 58%), although not advised by the ESHRE, while thyroid function (57%), thyroid auto-immunity (27%) and β2-glycoprotein antibodies (42%) in the context of antiphospholipid syndrome (APS) are recommended but investigated less often. Regarding parental
karyotyping, 20% of respondents stated they always perform parental
karyotyping, without prior risk assessment. because of RPL. Treatment for hereditary thrombophilia was frequently (43.8% (n = 137)) prescribed although not recommended. And finally, a considerable part (12-16%) of respondents prescribe medication in case of unexplained RPL.
CONCLUSIONS: While many clinicians perform investigations recommended by the ESHRE, there is a considerable variation of RPL practice in the Netherlands. We identified discrepancies between RPL guidelines and RPL practice, providing possibilities to focus on multifaceted implementation strategies, such as educational intervention, local
consensus processes and auditing and feedback. This will improve the quality of care provided to RPL patients and may diminish the necessity felt by patients to turn to multiple opinions or cross border reproductive care.