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Provider characteristics that predict periviable cesarean delivery.
MedLine Citation:
PMID:  24770091     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
INTRODUCTION: The objective of this study was to determine health care provider characteristics that predict periviable cesarean delivery practice patterns.
METHODS: We surveyed 295 obstetrician-gynecologists attending the American College of Obstetricians and Gynecologists' 2013 Annual Clinical Meeting about mode of delivery decisions for periviable (22-24 weeks of gestation) preterm premature rupture of membranes. Across 10 vignettes, physicians rated their likelihood of proceeding with cesarean delivery for breech fetuses (actively laboring and in fetal distress) from 0 (definitely would not) to 10 (definitely would) and then completed questionnaire items on sociodemographic characteristics and practice setting. Rating means were compared across physician characteristics and linear regression was used for multivariable analyses.
RESULTS: A total of 64.9% of study participants were female; 91.9% generalists and 4.3% maternal-fetal medicine specialists; and 29.9% practiced in the northeastern United States. In multivariable analyses, Catholic obstetricians were more likely to perform cesarean delivery for laboring patients than Protestant obstetricians (P=.029). Obstetricians reporting their institutional "cutoffs" for cesarean delivery at less than 24 weeks of gestation were more likely to perform cesarean delivery for labor and fetal distress (P=.032 and <.001, respectively). Conversely, obstetricians reporting that they would choose cesarean delivery for themselves or their loved ones at greater than 24 weeks of gestation were less likely to perform periviable cesarean delivery (P=.002 and P<.001 for labor and distress, respectively).
CONCLUSION: Physician characteristics and practice setting influence periviable decision-making regarding mode of delivery. These are high-stakes decisions with lifelong implications for patients and families. In the absence of patient preference elicitation, health care provider preferences and institutional norms may dominate the clinical course of care and undermine efforts to provide patient-centered periviable care. Interventions are needed to facilitate preference elicitation and values clarification in periviable counseling.
Authors:
Brownsyne M Tucker Edmonds; Fatima McKenzie; Richard Frankel
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  123 Suppl 1     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-04-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  176S     Citation Subset:  AIM; IM    
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