Standardized healthcare pathway in intrauterine growth restriction and minimum evidence-based care

被引:3
|
作者
Atallah, Anthony [1 ,2 ,3 ]
Butin, Marine [4 ,5 ]
Moret, Stephanie [1 ]
Claris, Olivier [4 ,6 ]
Massoud, Mona [1 ]
Gaucherand, Pascal [1 ,2 ,3 ]
Doret-Dion, Muriel [1 ,2 ,3 ]
机构
[1] Univ Hosp Ctr, Hosp Civils Lyon, Femme Mere Enfant Hosp, Dept Obstet & Gynecol, 59 Blvd Pinel, F-69500 Bron, France
[2] Univ Claude Bernard Lyon 1, Univ Lyon, F-69008 Lyon, France
[3] Univ St Etienne, HESPER EA 7425, F-42023 St Etienne, France
[4] Univ Hosp Ctr, Hosp Civils Lyon, Femme Mere Enfant Hosp, Dept Neonatal, 59 Blvd Pinel, F-69500 Bron, France
[5] Univ Lyon 1, CNRS, INSERM, Int Ctr Res Infectiol,UMR5308,U1111, Lyon, France
[6] Univ Lyon, EA 4129, Lyon, France
关键词
Growth restriction; Healthcare pathway; Evidence based care; Antenatal management; Ultrasound screening; Doppler measurement; Fetal growth restriction; Obstetrics; Prenatal care; FOR-GESTATIONAL-AGE; FETAL-GROWTH; FRENCH COLLEGE; MANAGEMENT; DEFINITION; GUIDELINES; DIAGNOSIS; CONSENSUS; DOPPLER;
D O I
10.1016/j.jogoh.2020.101998
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Introduction: Fetal growth restricted fetuses are less likely to receive evidence-based care; a previous work demonstrated an improvement in neonatal prognosis when fetuses with intrauterine growth restriction (IUGR) received minimum evidence based-care. Objective: The objective of the study was to evaluate the impact of a standardized healthcare pathway on the implementation of the recommended clinical practice in the antenatal management of IUGR fetuses, in comparison to a traditional pathway. The quality of the implementation of practice has been defined whether or not minimum evidence-based care (MEC), defined according to the recommendations of the French college of gynecologists and obstetricians (CNGOF), has been implemented. Study design: From a historical cohort of 31,052 children, born at the Femme Mere Enfant Hospital (Lyon, France) between January 1st, 2011 and December 31st, 2017, we selected the population of IUGR fetuses. We compared the rate of MEC between the IUGR fetuses followed-up in the traditional healthcare pathway versus the IUGR fetuses followed-up in a standardized healthcare pathway between 2015 and 2017. Results: A total of 245 IUGR were tracked between 2015 and 2017. Over this period, 120 fetuses were followed within the traditional pathway and 125 within the IUGR pathway. The standardized pathway resulted in a higher rate of MEC (86,4%) when compared to IUGR fetuses followed-up in the traditional pathway (27,5% (OR* 20 (95 % CI 10.0-39.7). Among early-onset IUGR: 31 % received MEC in the traditional pathway versus 83 % in the standardized pathway (p <0.001). Among late-onset IUGR: 22 % received MEC in the traditional pathway versus 92 % in the standardized pathway (p <0.001). The provided care in the standardized pathway resulted in an increase of complete antenatal corticosteroid therapy (92,8 %) when compared to the traditional pathway (50.0 %; p <0.001) and a reduction of the rate of caesarean sections before labor for non-reassuring fetal heart rate (15 %) when compared to the traditional pathway (41.3 % p = 0.007). Conclusion: The standardized pathway improves the implementation of the local recommendations in the management of early- and late-onset IUGR. This study is the first to suggest a standardized care pathway in prenatal medicine. A medico-economic study could estimate the health care savings that such a pathway would provide by allowing a medical management in accordance with the recommendations. (C) 2020 Elsevier Masson SAS. All rights reserved.
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页数:8
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