Care for the imminent miscarriage by midwives and GPs.
A postal questionnaire was sent to a random sample of 495 Dutch general practitioners (GPs) and 278 midwives to evaluate the use of the 'imminent miscarriage' standard used by the Dutch College of General Practitioners. The response rates were 63 and 87% respectively. The first questions asked related to the respondents' routine management of an imminent miscarriage. The second part of the questionnaire addressed the respondents' attitude to the 17 most important guidelines in the standard. Finally, the respondents were invited to describe problems arising in adhering to the standard. Midwives and GPs differed in their management of an imminent miscarriage. Midwives used more 'technology' such as ultrasound scans or a doptone to trace complications or see if the fetus was still viable, whereas the GPs more often carried out vaginal and speculum examinations. Midwives also paid more attention to care following a miscarriage. The guidelines that many respondents did not adhere to involved the period of 10 days for the follow-up appointment and counselling after 6 weeks. Guidelines restricting ultrasound scans and the decision only to refer the patients to an obstetrician after three consecutive miscarriages were also not accepted by all respondents. Respondents mentioned several practical problems or obstacles in adhering to the standard, including women's requests for ultrasound scans or referrals and also the attitude of obstetricians who sometimes simply assumed control. The results will serve as a starting point for updating the standard.
Free University Hospital, Research Centre Primary/Secondary Health Care, Amsterdam, The Netherlands.
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Fleuren
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Grol
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de Haan
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Wijkel
D000022:Abortion, Spontaneous / Q000175:diagnosis* / Q000628:therapy; D000033:Abortion, Threatened / Q000175:diagnosis* / Q000628:therapy; D000359:Aftercare; D005194:Family Practice; D005260:Female; D006801:Humans; D008880:Midwifery; D009426:Netherlands; D010348:Patient Care Team; D011247:Pregnancy; D012017:Referral and Consultation; D016216:Ultrasonography, Prenatal