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【medical-news】When pregnancies fail early, many woman cho
U-M Health System study represents shift in thinking about management of early pregnancy failures
Ann Arbor, Mich. -- Women who undergo surgery due to an early pregnancy failure usually are treated in an operating room, often under general anesthesia, but a new study raises questions about whether women prefer that approach.
Early pregnancy failure – or EPF – occurs in 14 to 19 percent of recognized pregnancies. Cases treated with surgery typically haven't been performed in an office-based setting, even while many other procedures have moved from the OR to the office. Now, a study from the University of Michigan Health System suggests that many women would choose the option of having the procedure done in the relative privacy of an office, without general anesthesia.
"We found that managing an early pregnancy failure in the office is an acceptable option for many women," says Vanessa K. Dalton, M.D., MPH, lead author of the study, which appeared recently in the journal Obstetrics & Gynecology. "This is a real shift in the way we can approach the care of women with EPF. Many other procedures have moved from the operating room into an ambulatory setting, but for the most part, the management of EPF has not.
"This is a difficult experience for women, and we want to make sure that we are offering them the type of care that works best for them and which they prefer," Dalton says.
Studies indicate that sharp curettage (scraping) and general anesthesia are still common when performing this procedure in the operating room – despite evidence associating them with higher complication rates than suction removal without general anesthesia, says Dalton, assistant professor of obstetrics and gynecology at the U-M Medical School.
The study also found:
Costs were more than twice as much in the operating room compared to the office procedures, and the procedure was 80 percent longer. Physician reimbursement did not differ between the two groups.
While the study did not demonstrate that office-based procedures are safer than traditional operating room management, the authors said they are concerned about the four-fold increase in bleeding-related complications in the operating room group in this study. The most likely explanation for this finding was that all but one of the operating room procedures were done under general anesthesia, which may contribute to increased blood loss.
Patients opting to have the office procedure reported expecting higher levels of pain than those going to the operating room, and as anticipated, they reported higher pain scores.
There were no major complications in either group. Further, no office procedure was moved to the operating room or converted to general anesthesia for patient discomfort.
Those enrolled in the study were women 18 and older who came to the U-M Department of Obstetrics and Gynecology for surgical management of a first-trimester early pregnancy. In all, 165 women enrolled in the study, including 115 in the office group and 50 who chose the operating room.
Participants completed a self-administered questionnaire at the time of enrollment. Immediately before discharge, they completed a second questionnaire addressing pain, bleeding and satisfaction with care.
The findings "dispute the notion that current practices are based on patient preferences," Dalton says. "Overall, our institution's experience has been that about half of women choose to have their procedures completed in the office. In the study group, only 25 percent of study participants reported that being asleep for the procedure was highly important. Instead, many participants opted for an office procedure that better meets other needs such as privacy and efficiency.
"It is important that we pay attention to their wishes and offer the services that best meet their needs," she says. 许多妇女早期怀孕失败后更愿意选择诊所治疗
U-M健康系统研究反映在治疗早期怀孕失败思考上的转变 Ann Arbor 密西根州
早期妊娠失败的妇女通常在手术室全麻情况下接受治疗，一项新的研究对妇女是否愿意接受这样的治疗产生了质疑。早期怀孕失败（EPF）在确认怀孕者中的占14－19％。这种病例的典型手术治疗不会在一个诊所环境下进行，也并没有向其他手术那样从手术室转移到诊所。现在，一项来自密西根大学健康系统的研究表明许多妇女希望治疗选择在相对隐私的诊所并且无需全身麻醉的情况下进行。
“对许多妇女来说，在诊所进行早孕失败的治疗更加合适”。Vanessa K. Dalton医学博士，公共卫生学硕士如是说。她是这项最近发表在妇产科学杂志上的研究的主要作者。“在处理早孕失败的方法上，这的确是个转变。许多其他的治疗已经从手术室转移到诊所，但对大多数早孕失败的治疗来说这种情况并没有发生。”
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作者:admin@医学,生命科学 2011-02-19 17:14
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