Tucker Edmonds B, McKenzie F, Farrow V, Raglan G, Schulkin J
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
1] Research Department, American College of Obstetricians and Gynecologists, Washington, DC, USA [2] Department of Psychology, American University, Washington, DC, USA.
J Perinatol. 2015 May;35(5):338-43. doi: 10.1038/jp.2014.201. Epub 2014 Nov 6.
Test the association between provider characteristics and antenatal interventions offered for periviable delivery.
Six hundred surveys mailed to members of the College's Collaborative Ambulatory Research Network. Items queried physicians' practices regarding administering steroids, recommending cesarean (for breech) and offering induction (for ruptured membranes) at 23 weeks.
Three hundred and ten (52%) obstetricians (OBs) responded. Respondents reported institutional cutoffs of 23 weeks for resuscitation (34%) and 24 weeks for cesarean (35%), whereas personal preferences for cesarean were ⩾25 weeks (44%). At 23 weeks, two-thirds ordered steroids, 43% recommended cesarean and 23% offered induction. In multivariable analyses, institutional cutoffs and providers' personal preferences predicted steroid administration (odds ratio, OR=4.37; 95% confidence interval, CI=1.73 to 11.00; OR=0.30, 95% CI=0.13 to 0.70); institutional cutoffs and the impression that cesarean decreases neurodevelopmental disability predicted recommending cesarean (OR=3.09, 95% CI=1.13 to 8.44; OR=6.41, 95% CI=2.06 to 19.91). For offering induction, practice location and religious service attendance approached, but did not meet, statistical significance (P=0.06 and P=0.05).
OBs' willingness to intervene can impact periviable outcomes. These findings suggest that personal and institutional factors may influence obstetrical counseling and decision-making.
测试医疗服务提供者的特征与为接近可存活孕周分娩所提供的产前干预措施之间的关联。
向该学院协作门诊研究网络的成员邮寄了600份调查问卷。问题涉及医生在23周时使用类固醇、推荐剖宫产（用于臀位）以及提供引产（用于胎膜破裂）的做法。
310名（52%）产科医生回复。受访者报告机构对于复苏的孕周截止值为23周（34%），剖宫产为24周（35%），而个人对剖宫产的偏好为≥25周（44%）。在23周时，三分之二的医生开出了类固醇，43%推荐剖宫产，23%提供引产。在多变量分析中，机构截止值和提供者的个人偏好预测了类固醇的使用（比值比，OR = 4.37；95%置信区间，CI = 1.73至11.00；OR = 0.30，95% CI = 0.13至0.70）；机构截止值以及剖宫产可降低神经发育障碍的观念预测了推荐剖宫产（OR = 3.09，95% CI = 1.13至8.44；OR = 6.41，95% CI = 2.06至19.91）。对于提供引产，执业地点和参加宗教活动情况接近但未达到统计学显著性（P = 0.06和P = 0.05）。
产科医生的干预意愿会影响接近可存活孕周的分娩结局。这些发现表明个人和机构因素可能会影响产科咨询和决策。
