Edmonds B Tucker, McKenzie F, Hendrix K S, Perkins S M, Zimet G D
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
J Perinatol. 2015 Mar;35(3):161-6. doi: 10.1038/jp.2014.175. Epub 2014 Sep 25.
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.
确定患者的复苏偏好对可存活孕周分娩管理的相对影响。
就可存活孕周的胎膜早破处理问题，对295名妇产科医生进行了调查。在10个案例中，我们系统地改变了孕周、职业、受孕方式和复苏偏好。医生们对进行引产、使用类固醇和剖宫产的可能性进行了评分（0至10分）。通过联合分析对数据进行了分析。
纳入了205名医生的回复。管理决策的中位数评分如下：引产1.89分；类固醇5.00分；产时剖宫产3.89分；窘迫时剖宫产4.11分。在所有决策中，孕周对医生评分的影响最大（重要性值范围为72.6至86.6），其次是患者的复苏偏好（范围为9.3至21.4）。
在妇产科医生关于可存活孕周分娩管理的决策中，孕周的权重比患者的复苏偏好更大。产前管理与父母复苏偏好不一致可能会对可存活孕周的结局产生不利影响。需要采取干预措施，以促进在可存活孕周护理中做出更以患者为中心的决策。
