Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of General Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Med Ethics. 2018 Apr;44(4):234-238. doi: 10.1136/medethics-2017-104377. Epub 2017 Oct 10.
While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes.
Survey of 1200 paediatric surgeons, neonatologists and maternal-fetal medicine specialists (MFMs).
Of 1176 eligible physicians, 670 (57%) responded (range by specialty, 54%-60%). In the setting of a lethal condition for which prenatal surgery would likely result in the child surviving with a severe disability, most respondents either disagreed (59%) or strongly disagreed (19%) that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong (OR 1.75; 95%CI 1.0 to 3.05). Older physicians were less likely to recommend surgery (OR 0.57; 95%CI 0.36 to 0.88). For non-lethal conditions, most respondents agreed (66% somewhat, 4% strongly) that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious (ORs range from 0.45 to 0.64).
Physician's attitudes about prenatal surgery relate to physicians' beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice.
虽然产前手术历史上仅用于致命疾病，但现在宫内手术也用于减少非致命疾病的产后残疾。我们旨在描述医生对致命和非致命疾病的产前手术的态度，并阐明与这些态度相关的特征。
对 1200 名儿科外科医生、新生儿科医生和母胎医学专家（MFMs）进行调查。
在一种致命疾病的情况下，产前手术可能导致孩子存活下来，但存在严重残疾，大多数受访者要么不同意（59%），要么强烈不同意（19%）他们会推荐这种手术。男性医生对这种致命疾病进行手术的可能性是女性医生的两倍，而那些认为堕胎在道德上是错误的医生也是如此（OR 1.75；95%CI 1.0 至 3.05）。年长的医生不太可能推荐手术（OR 0.57；95%CI 0.36 至 0.88）。对于非致命疾病，大多数受访者同意（66%有些，4%强烈）他们会推荐产前手术，即使手术增加早产或胎儿死亡的风险。与 MFMs 相比，外科医生不太可能推荐这种手术，与没有胎儿中心的医生相比，与宗教有关的医生（OR 范围从 0.45 到 0.64）也是如此。
医生对产前手术的态度与医生对残疾的信念以及人口统计学、文化和宗教特征有关。鉴于观点的多样性，父母可能会从他们的医生那里得到不同的治疗选择建议。
