Brigham and Women's Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, Boston, MA (Dr Koenigs).
Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA (Drs Chou, Cohen, Cummings, and Schiff).
Am J Obstet Gynecol MFM. 2022 Jul;4(4):100621. doi: 10.1016/j.ajogmf.2022.100621. Epub 2022 Mar 27.
Positive toxicology testing at delivery can have enormous consequences for birthing persons and their families, including charges of child abuse or neglect and potential loss of custody for the birthing parent. Therefore state and national guidelines stipulate that, clinicians must obtain consent before toxicology testing at delivery.
This study aimed (1) to determine clinician documentation of patient consent for peripartum toxicology testing and (2) to characterize the extent to which patient and hospital characteristics were associated with documented consent.
This was a retrospective cohort of individuals who underwent toxicology testing within 96 hours of delivery between April 2016 and April 2020 at 5 affiliated hospitals across Massachusetts. Medical records were reviewed for documentation of clinician intent to obtain maternal toxicology, testing indication, verbal consent to testing, and child protective services involvement. Hierarchical multivariable logistic regression was used to examine the association between patient and hospital characteristics and documentation of verbal consent.
Among 60,718 deliveries, 1562 maternal toxicology tests were obtained. Verbal consent for testing was documented in 466 cases (29.8%). Documented consent was lacking across most demographic groups. Consent was no more likely to be documented when a report was filed with child protective services and less likely in cases where the birthing parent lost custody before discharge (P=.003). In our multivariable model, consent was least likely to be documented when a maternal complication (abruption, hypertension, preterm labor, preterm premature rupture of membranes, or intrauterine fetal demise) was the indication for testing (adjusted odds ratio, 0.46; 95% confidence interval, 0.28-0.76). Verbal consent was twice as likely to be documented in delivery hospitals with established consent policies (adjusted odds ratio, 2.10; 95% confidence interval, 1.01-4.37).
Consent for toxicology testing at delivery seemed to be infrequently obtained on the basis of clinician documentation. Provider education and hospital policies for obtaining informed consent are needed to protect the rights of birthing individuals.
分娩时的阳性毒理学检测结果可能会对分娩者及其家人产生巨大影响，包括虐待或忽视儿童的指控，以及分娩父母可能失去监护权。因此，州和国家指南规定，临床医生必须在分娩时进行毒理学检测前获得同意。
本研究旨在：(1)确定临床医生记录产妇同意进行围产期毒理学检测的情况；(2)描述患者和医院特征与记录同意之间的关系。
这是一项回顾性队列研究，研究对象为 2016 年 4 月至 2020 年 4 月期间在马萨诸塞州 5 家附属医院分娩后 96 小时内进行毒理学检测的个体。对病历进行了审查，以记录临床医生进行产妇毒理学检测的意向、检测指征、口头同意检测以及儿童保护服务机构的参与情况。采用分层多变量逻辑回归分析患者和医院特征与口头同意记录之间的关系。
在 60718 例分娩中，有 1562 例进行了产妇毒理学检测。466 例（29.8%）记录了口头同意检测。在大多数人群中，都缺乏记录同意的情况。当向儿童保护服务机构提交报告时，记录同意的可能性更小，而在分娩父母在出院前失去监护权的情况下，记录同意的可能性更小（P=0.003）。在多变量模型中，当检测指征为母体并发症（胎盘早剥、高血压、早产、胎膜早破或胎儿宫内死亡）时，最不可能记录同意（调整后的优势比，0.46；95%置信区间，0.28-0.76）。在已建立同意政策的分娩医院中，口头同意的记录可能性是两倍（调整后的优势比，2.10；95%置信区间，1.01-4.37）。
根据临床医生的记录，分娩时毒理学检测的同意似乎很少获得。需要对提供者进行教育，并制定获取知情同意的医院政策，以保护分娩者的权利。
