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Do maternal characteristics influence maternal–fetal medicine physicians’ willingness to intervene when managing periviable deliveries?

Journal of Perinatology volume 36, pages 522–528 (2016)Cite this article

Subjects

Abstract

Objective:

Determine the relative influence of patient characteristics on Maternal–Fetal Medicine (MFM) physicians’ willingness to intervene when managing 23-week preterm premature rupture of membranes.

Study Design:

Surveyed 750 randomly sampled US members of the Society of Maternal–Fetal Medicine. Physicians rated their willingness to offer induction, order steroids and perform cesarean across eight vignettes; then completed a questionnaire querying expectations about neonatal outcomes and demographics.

Results:

Three hundred and twenty-five (43%) MFMs responded. Patient characteristics only influenced ⩽11% of participants’ willingness ratings. Overall, provider characteristics and institutional norms were associated with willingness to perform antenatal interventions, for example, practice region was associated with willingness to offer induction (P<0.001), order steroids (P=0.008) and perform cesarean for distress (P=0.011); while institutional cesarean cutoffs were associated with willingness to order steroids and perform cesarean for labor and distress (all P<0.001).

Conclusion:

Physician-level factors and institutional norms, more so than patient characteristics, may drive periviable care and outcomes.

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Acknowledgements

This publication was made possible in part by Grant Number KL2 TR000163 (A. Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award; the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program; and the Indiana University Purdue University Indianapolis’ Enhanced Mentoring Program with Opportunities for Ways to Excel in Research (EMPOWER) Grant Program.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA

    F McKenzie & B Tucker Edmonds

  2. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA

    B K Robinson

Authors
  1. F McKenzie
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Correspondence to B Tucker Edmonds.

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McKenzie, F., Robinson, B. & Tucker Edmonds, B. Do maternal characteristics influence maternal–fetal medicine physicians’ willingness to intervene when managing periviable deliveries?. J Perinatol 36, 522–528 (2016). https://doi.org/10.1038/jp.2016.15

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