Dotters-Katz Sarah K, Smid Marcela C, Mcelwain Cora, Kuller Jeffrey A, Schulkin Jay
a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of North Carolina , Chapel Hill , NC , USA.
b Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah , Salt Lake City , UT , USA.
J Matern Fetal Neonatal Med. 2018 Sep;31(18):2441-2445. doi: 10.1080/14767058.2017.1344638. Epub 2017 Jul 11.
Describe practice patterns among obstetrician/gynecologists (OB/GYNs) when caring for women with pregnancy complicated by fetal trisomy 13 (T13) or 18 (T18) and compare these between maternal-fetal medicine (MFM) and non-MFM providers.
We conducted an electronic survey using the American College of Obstetricians and Gynecologists database. Using simple statistics, we describe demographics and practice patterns among respondents and compare those of MFM practitioners with non-MFM providers.
The survey was sent to 300 individuals, 161 individuals verified email receipt, and 105 had complete response and were included. The median age was 58 (IQR 53,62). Sixty percent were female, 69% were private practice, and 38% were MFM. All providers were more likely to offer than to recommend antenatal and intrapartum interventions. MFMs were more likely to offer growth ultrasounds and neonatal hospice consults (53% vs. 29%, p = .02; 88% vs. 60%, p < .01). During labor, MFMs were more likely offer no fetal heart rate monitoring, (90% vs. 52%, p < .01), 60% of all providers offer breech vaginal delivery; 32% offer cesarean delivery for fetal distress.
Many providers offer antepartum and intrapartum interventions for pregnancies complicated by T13/18. We recommend that providers elicit each woman's goals for pregnancies complicated by T13/18 and tailor management options to meet these goals.
描述妇产科医生在照料妊娠合并胎儿13三体（T13）或18三体（T18）的女性时的临床实践模式，并比较母胎医学（MFM）提供者和非MFM提供者之间的差异。
我们使用美国妇产科医师学会数据库进行了一项电子调查。通过简单统计，我们描述了受访者的人口统计学特征和临床实践模式，并比较了MFM从业者与非MFM提供者的差异。
该调查发送给了300个人，161个人确认收到电子邮件，105个人给出了完整回复并被纳入研究。中位年龄为58岁（四分位间距53,62）。60%为女性，69%为私人执业，38%为MFM。所有提供者更倾向于提供而非推荐产前和产时干预措施。MFM提供者更有可能提供生长超声检查和新生儿临终关怀咨询（53%对29%，p = 0.02；88%对60%，p < 0.01）。在分娩期间，MFM提供者更有可能不进行胎儿心率监测（90%对52%，p < 0.01），所有提供者中有60%提供臀位阴道分娩；32%因胎儿窘迫行剖宫产。
许多提供者对妊娠合并T13/T18的情况提供产前和产时干预措施。我们建议提供者了解每位妊娠合并T13/T18的女性的妊娠目标，并调整管理方案以实现这些目标。
