Reported management of early-pregnancy bleeding and miscarriage by general practitioners in Victoria.
OBJECTIVE
To describe the management of early-pregnancy bleeding and miscarriage reported by general practitioners in Victoria.


METHODS
Self-administered, mailed survey of a stratified random sample of GPs in Victoria. Responses weighted by strata to reflect GP population.


METHODS
Reported management in referral; investigation (especially ultrasound); expectant versus interventional management; and prevention of rhesus iso-immunisation


RESULTS
382 of 621 eligible GPs responded (response rate, 62%). GPs' reported referral was more likely if the patient had painful bleeding (55%) or if the pregnancy was not viable (77%). Ultrasound strongly influenced the assessment of bleeding. Two-thirds of doctors (262/369; 66%) would routinely order ultrasound for painless bleeding, and 328/369 (84%) for painful bleeding. Expectant management was recommended by 15/353 (4%) for incomplete miscarriage with light bleeding and by 6/351 (2%) when bleeding was heavy. Some GPs are uncertain of the indications for anti-D prophylaxis, including instrumentation of the uterus, for which 261/337 (77%) said they would routinely offer anti-D. There was less agreement about anti-D after threatened miscarriage, for which 213/353 (57%) said they offered the injection.


CONCLUSIONS
GPs need a working knowledge of the management of early-pregnancy bleeding, and can probably encourage more rational management. There are significant areas where GPs are uncertain, often reflecting uncertainty elsewhere, and some areas where a minority of GPs are not aware of essential requirements.
Mclaren
Bruce
B
Centre for the Study of Mothers' and Children's Health, La Trobe University, Melbourne, VIC. bruce.mclaren@dfat.gov.au
Shelley
Julia M
JM
D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging / Q000628:therapy*; D000033:Abortion, Threatened / Q000000981:diagnostic imaging / Q000628:therapy*; D002983:Clinical Competence; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use; D014463:Ultrasonography; D014739:Victoria
D018029:Rho(D) Immune Globulin