Your browser doesn't support javascript.
loading
Standardized healthcare pathway in intrauterine growth restriction and minimum evidence-based care.
Atallah, Anthony; Butin, Marine; Moret, Stéphanie; Claris, Olivier; Massoud, Mona; Gaucherand, Pascal; Doret-Dion, Muriel.
Afiliação
  • Atallah A; Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France; University of Lyon, University Claude Bernard Lyon 1, University of Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne,
  • Butin M; Hospices Civils de Lyon, Department of Neonatalogy, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel 69500, Bron, France; International Center for Research in Infectiology, INSERM U1111, CNRS UMR5308, University of Lyon 1, Lyon, France. Electronic address: marine.butin@chu-
  • Moret S; Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France. Electronic address: stephanie.moret@chu-lyon.fr.
  • Claris O; Hospices Civils de Lyon, Department of Neonatalogy, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel 69500, Bron, France; University of Lyon, EA, 4129, Lyon, France. Electronic address: olivier.claris@chu-lyon.fr.
  • Massoud M; Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France. Electronic address: mona.massoud@chu-lyon.fr.
  • Gaucherand P; Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France; University of Lyon, University Claude Bernard Lyon 1, University of Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne,
  • Doret-Dion M; Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France; University of Lyon, University Claude Bernard Lyon 1, University of Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne,
J Gynecol Obstet Hum Reprod ; 50(1): 101998, 2021 Jan.
Article em En | MEDLINE | ID: mdl-33221557
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 Mère 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.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cuidado Pré-Natal / Procedimentos Clínicos / Medicina Baseada em Evidências / Retardo do Crescimento Fetal Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Pregnancy Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cuidado Pré-Natal / Procedimentos Clínicos / Medicina Baseada em Evidências / Retardo do Crescimento Fetal Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Pregnancy Idioma: En Ano de publicação: 2021 Tipo de documento: Article