The influence of resuscitation preferences on obstetrical management of periviable deliveries

To determine the relative influence of patients' resuscitation preferences on periviable delivery management. Surveyed 295 obstetrician-gynecologists about managing periviable preterm premature rupture of membranes. Across 10 vignettes, we systematically varied gestational age, occupation, meth...

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Bibliographic Details
Published in:Journal of perinatology 2015-03, Vol.35 (3), p.161-166
Main Authors: Edmonds, B Tucker, McKenzie, F, Hendrix, K S, Perkins, S M, Zimet, G D
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Cesarean Section
Childbirth
Decision Making
Female
Fetal Viability
Gestational Age
Health aspects
Humans
Influence
Labor, Induced
Male
Management
Membranes
Methods
Middle Aged
Misalignment
Obstetricians
Obstetrics
Patient Preference
Patients
Personal preferences (Social sciences)
Physicians
Practice
Preferences
Ratings
Resuscitation
Steroid hormones
Steroids
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Summary:To determine the relative influence of patients' resuscitation preferences on periviable delivery management. Surveyed 295 obstetrician-gynecologists about managing periviable preterm premature rupture of membranes. Across 10 vignettes, we systematically varied gestational age, occupation, method of conception and resuscitation preference. Physicians rated their likelihood (0 to 10) of proceeding with induction, steroids and cesarean. Data were analyzed via conjoint analysis. Two hundred and five physician responses were included. Median ratings for management decisions were: induction 1.89; steroids 5.00; cesarean for labor 3.89; and cesarean for distress 4.11. Gestational age had the greatest influence on physician ratings across all decisions (importance values ranging from 72.6 to 86.6), followed by patient's resuscitation preference (range=9.3 to 21.4). Gestational age is weighted more heavily than patients' resuscitation preferences in obstetricians' decision making for periviable delivery management. Misalignment of antenatal management with parental resuscitation preferences may adversely affect periviable outcomes. Interventions are needed to facilitate more patient-centered decision making in periviable care.
ISSN:0743-8346
1476-5543
DOI:10.1038/jp.2014.175