Journal de gynecologie, obstetrique et biologie de la reproduction · 2015
[Evaluation of the feasibility of ultrasound in a community care outpatient pregnancy assessment clinic for high-risk pregnancies].
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Bil N, Eggermann V, Roueli A, Nizard J
Аннотация
OBJECTIVES: To assess the clinical, legal, and technical roles of ultrasound in an outpatient pregnancy assessment clinic, while evaluating the feasibility for these consultations to be performed at home.
MATERIALS AND METHODS: We prospectively assessed all consultations from April 3 to May 31, 2013, at the outpatient pregnancy assessment clinic of La Pitié-Salpêtrière, Paris, France. We recorded all procedures and the number and type of ultrasound examination performed, according to their indication. For each consultation, we evaluated whether the routine protocols were sufficient or if the attending obstetrician was asked for advice. Finally, we asked the patients if they would prefer having this consultation in a home-care setting.
RESULTS: We recorded 429 consultations (n) for 234 patients (Np). Indications were diabetes (n=106/Np=59), assessment of fetal growth (n=90/Np=43), another single indication (n=106/Np=59), multiple indications (n=46/Np=12), term pregnancies (n=39/Np=30), and a history of abnormal pregnancy (n=27/Np=10). CTG was performed for 91 % of consultations, blood samples for 10 %, and ultrasound for 88 %, which included amniotic fluid evaluation (79 %), umbilical Doppler (69 %), fetal biometries (36 %), uterine artery Doppler (0.7 %), cervical length (2 %), suspicion of breech presentation (4 %) and placenta position (0.7 %). Most of these ultrasound examinations could not be financially value if performed by a midwife. Routine protocols were sufficient for the management of 68 % of these consultations, 26 % required the attending obstetrician, and 6 % were finally low-risk. Performing these consultations in a home-care setting was medically possible and requested by the patient for 16 % of consultations (6 % of patients).
CONCLUSION: These are encouraging results to experiment the outpatient pregnancy assessment clinic in a home-care setting, although the financial valorization system in France is poorly adapted.
MATERIALS AND METHODS: We prospectively assessed all consultations from April 3 to May 31, 2013, at the outpatient pregnancy assessment clinic of La Pitié-Salpêtrière, Paris, France. We recorded all procedures and the number and type of ultrasound examination performed, according to their indication. For each consultation, we evaluated whether the routine protocols were sufficient or if the attending obstetrician was asked for advice. Finally, we asked the patients if they would prefer having this consultation in a home-care setting.
RESULTS: We recorded 429 consultations (n) for 234 patients (Np). Indications were diabetes (n=106/Np=59), assessment of fetal growth (n=90/Np=43), another single indication (n=106/Np=59), multiple indications (n=46/Np=12), term pregnancies (n=39/Np=30), and a history of abnormal pregnancy (n=27/Np=10). CTG was performed for 91 % of consultations, blood samples for 10 %, and ultrasound for 88 %, which included amniotic fluid evaluation (79 %), umbilical Doppler (69 %), fetal biometries (36 %), uterine artery Doppler (0.7 %), cervical length (2 %), suspicion of breech presentation (4 %) and placenta position (0.7 %). Most of these ultrasound examinations could not be financially value if performed by a midwife. Routine protocols were sufficient for the management of 68 % of these consultations, 26 % required the attending obstetrician, and 6 % were finally low-risk. Performing these consultations in a home-care setting was medically possible and requested by the patient for 16 % of consultations (6 % of patients).
CONCLUSION: These are encouraging results to experiment the outpatient pregnancy assessment clinic in a home-care setting, although the financial valorization system in France is poorly adapted.