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Variability of Clinical Practice in the Third Stage of Labour in Spain

Clinical practice guidelines recommend the active management of the third stage of labour, but it is currently unknown what practices professionals actually perform. Therefore, the aim of this study was to determine the variability of professional practices in the management of the third stage of la...

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Autores principales: Ortiz-Esquinas, Inmaculada, Gómez-Salgado, Juan, Pascual-Pedreño, Ana I., Rodríguez-Almagro, Julián, Martínez-Galiano, Juan Miguel, Hernández-Martínez, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571899/
https://www.ncbi.nlm.nih.gov/pubmed/31075863
http://dx.doi.org/10.3390/jcm8050637
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author Ortiz-Esquinas, Inmaculada
Gómez-Salgado, Juan
Pascual-Pedreño, Ana I.
Rodríguez-Almagro, Julián
Martínez-Galiano, Juan Miguel
Hernández-Martínez, Antonio
author_facet Ortiz-Esquinas, Inmaculada
Gómez-Salgado, Juan
Pascual-Pedreño, Ana I.
Rodríguez-Almagro, Julián
Martínez-Galiano, Juan Miguel
Hernández-Martínez, Antonio
author_sort Ortiz-Esquinas, Inmaculada
collection PubMed
description Clinical practice guidelines recommend the active management of the third stage of labour, but it is currently unknown what practices professionals actually perform. Therefore, the aim of this study was to determine the variability of professional practices in the management of the third stage of labour and to identify any associated professional and work environment factors. A nationwide cross-sectional study was performed with 1054 obstetrics professionals between September and November 2018 in Spain. A self-designed questionnaire was administered online. The crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. The main outcome measures were included in the clinical management of the third stage of labour and they were: type of management, drugs, doses, routes of administration, and waiting times used. The results showed that 75.3% (783) of the professionals used uterotonic agents for delivery. Oxytocin was the most commonly administered drug. Professionals who attend home births were less likely to use uterotonics (ORa: 0.23; 95% confidence interval (CI): 0.12–0.47), while those who completed their training after 2007 (ORa: 1.57 (95% CI: 1.13–2.18) and worked in a hospital that attended >4000 births per year (ORa: 7.95 CI: 4.02–15.72) were more likely to use them. Statistically significant differences were also observed between midwives and gynaecologists as for the clinical management of this stage of labour (p < 0.005). These findings could suggest that there is clinical variability among obstetrics professionals regarding the management of delivery. Part of this variability can be attributed to professional and work environment factors.
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spelling pubmed-65718992019-06-18 Variability of Clinical Practice in the Third Stage of Labour in Spain Ortiz-Esquinas, Inmaculada Gómez-Salgado, Juan Pascual-Pedreño, Ana I. Rodríguez-Almagro, Julián Martínez-Galiano, Juan Miguel Hernández-Martínez, Antonio J Clin Med Article Clinical practice guidelines recommend the active management of the third stage of labour, but it is currently unknown what practices professionals actually perform. Therefore, the aim of this study was to determine the variability of professional practices in the management of the third stage of labour and to identify any associated professional and work environment factors. A nationwide cross-sectional study was performed with 1054 obstetrics professionals between September and November 2018 in Spain. A self-designed questionnaire was administered online. The crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. The main outcome measures were included in the clinical management of the third stage of labour and they were: type of management, drugs, doses, routes of administration, and waiting times used. The results showed that 75.3% (783) of the professionals used uterotonic agents for delivery. Oxytocin was the most commonly administered drug. Professionals who attend home births were less likely to use uterotonics (ORa: 0.23; 95% confidence interval (CI): 0.12–0.47), while those who completed their training after 2007 (ORa: 1.57 (95% CI: 1.13–2.18) and worked in a hospital that attended >4000 births per year (ORa: 7.95 CI: 4.02–15.72) were more likely to use them. Statistically significant differences were also observed between midwives and gynaecologists as for the clinical management of this stage of labour (p < 0.005). These findings could suggest that there is clinical variability among obstetrics professionals regarding the management of delivery. Part of this variability can be attributed to professional and work environment factors. MDPI 2019-05-09 /pmc/articles/PMC6571899/ /pubmed/31075863 http://dx.doi.org/10.3390/jcm8050637 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ortiz-Esquinas, Inmaculada
Gómez-Salgado, Juan
Pascual-Pedreño, Ana I.
Rodríguez-Almagro, Julián
Martínez-Galiano, Juan Miguel
Hernández-Martínez, Antonio
Variability of Clinical Practice in the Third Stage of Labour in Spain
title Variability of Clinical Practice in the Third Stage of Labour in Spain
title_full Variability of Clinical Practice in the Third Stage of Labour in Spain
title_fullStr Variability of Clinical Practice in the Third Stage of Labour in Spain
title_full_unstemmed Variability of Clinical Practice in the Third Stage of Labour in Spain
title_short Variability of Clinical Practice in the Third Stage of Labour in Spain
title_sort variability of clinical practice in the third stage of labour in spain
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571899/
https://www.ncbi.nlm.nih.gov/pubmed/31075863
http://dx.doi.org/10.3390/jcm8050637
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