Kerns J L, Turk J K, Corbetta-Rastelli C M, Rosenstein M G, Caughey A B, Steinauer J E
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 1001 Potrero Avenue, Ward 6D, San Francisco, CA, 94110, USA.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA, 94158, USA.
BMC Womens Health. 2020 Feb 3;20(1):20. doi: 10.1186/s12905-020-0889-9.
Patients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive. We sought to compare maternal-fetal medicine (MFM) and family planning (FP) physicians' attitudes and practice patterns around second-trimester abortion for abnormal pregnancies.
We surveyed members of the Society for Maternal-Fetal Medicine and Family Planning subspecialists in 2010-2011 regarding provider recommendations between D&E or induction termination for various case scenarios. We assessed provider beliefs about patient preferences and method safety regarding D&E or induction for various indications. We compared responses by specialty using descriptive statistics and conducted unadjusted and adjusted analyses of factors associated with recommending a D&E.
Seven hundred ninety-four (35%) physicians completed the survey (689 MFMs, 105 FPs). We found that FPs had 3.9 to 5.5 times higher odds of recommending D&E for all case scenarios (e.g. 80% of FPs and 41% of MFMs recommended D&E for trisomy 21). MFMs with exposure to family planning had greater odds of recommending D&E for all case scenarios (p < 0.01 for all). MFMs were less likely than FPs to believe that patients prefer D&E and less likely to feel that D&E was a safer method for different indications.
Recommendations for D&E or induction vary significantly depending on the type of physician providing the counseling. The decision to undergo D&E or induction is one of clinical equipoise, and physicians should provide unbiased counseling. Further work is needed to understand optimal approaches to shared decision making for this clinical decision.
决定因胎儿异常或并发症而接受扩张刮宫术（D&E）或引产的患者可能会受到所接受咨询的极大影响。我们试图比较母胎医学（MFM）医生和计划生育（FP）医生对于孕中期异常妊娠流产的态度和实践模式。
我们在2010 - 2011年对母胎医学协会成员和计划生育亚专科医生进行了调查，内容涉及针对各种病例情况在D&E或引产终止妊娠之间的医疗服务提供者建议。我们评估了医疗服务提供者对于患者偏好以及D&E或引产针对各种适应症的方法安全性的看法。我们使用描述性统计方法比较了不同专业的回答，并对与推荐D&E相关的因素进行了未调整和调整后的分析。
794名（35%）医生完成了调查（689名MFM医生，105名FP医生）。我们发现，在所有病例情况下，FP医生推荐D&E的几率高出3.9至5.5倍（例如，80%的FP医生和41%的MFM医生推荐对21三体综合征进行D&E）。有计划生育工作经历的MFM医生在所有病例情况下推荐D&E的几率更高（所有情况p < 0.01）。MFM医生比FP医生更不太可能认为患者更喜欢D&E，也更不太可能觉得D&E对于不同适应症是更安全的方法。
对于D&E或引产的建议因提供咨询的医生类型不同而有显著差异。决定进行D&E或引产是一个临床权衡问题，医生应提供无偏见的咨询。需要进一步开展工作以了解针对这一临床决策的最佳共同决策方法。
