Verwijsredenen van huisartsen en verloskundigen in Amsterdam bij (dreigende) miskraam gespiegeld aan de standaard '(Dreigende) miskraam' van het Nederlands Huisartsen Genootschap

Objective. To determine the reasons general practitioners (GPs) and midwives have for referring patients with symptoms of imminent miscarriage to hospital and the management in hospital. Design. Prospective and descriptive. Setting. Research Centre Primary/Secondary Health Gare, University Hospital Free University, the 'Onze Lieve Vrouwe Gasthuis' hospital, both in Amsterdam, the Netherlands. Method. During the period August 1994-February 1995 anamnesis, diagnostics, diagnosis and further management were recorded for all patients who visited the 'Onze Lieve Vrouwe Gasthuis' hospital with blood loss and/or pain in the first 16 weeks of gestation. Patients revealed their wishes concerning referral by filling in questionnaires. Their GPs/midwives were asked about the referral motives in a telephone interview. Results. In the hospital 105 patients were recorded; 34% came on their own initiative. In hospital none of the patients with the diagnosis 'imminent miscarriage' was referred back to the GP/midwife. Only 59% of the GPs/midwives performed the physical examinations the (imminent) miscarriage guideline of the Dutch Gollege of General Practitioners advises. In 56% of the 32 patients referred there was no reason for referral according to the (imminent) miscarriage guideline. Conclusion. The (imminent) miscarriage guideline issued by the Dutch College of General Practitioners was not always followed because patients went to the hospital on their own account, GPs/midwives did not agree with the guideline, patients wanted another policy and obstetricians kept patients in their own care.