Variations between family physicians and obstetricians in the evaluation and treatment of preterm labor.

BACKGROUND

The purpose of this study was to examine and compare the approaches of family physicians and obstetricians when evaluating and managing women with preterm contractions or labor.

METHODS

A survey questionnaire examining physician practice characteristics was sent to a random sample of specialists in obstetrics and family practice in 10 states. Responses were received from 54% of individuals in active practice.

RESULTS

When asked their three most common treatment strategies for women with preterm labor, family physicians were more likely than obstetricians to select beta-agonists and hydration. Obstetricians were more likely to include magnesium sulfate and nifedipine in their treatment plans. For women with preterm contractions and no change in cervix, obstetricians were more likely to select either of the two short-term tocolytic therapies, while family physicians were more likely to select less aggressive therapy approaches. When adjusted for the facility in which they practiced and the number of years of experience, family physicians were nearly one half as likely as obstetricians to use tocolytics to treat women who had contractions but no cervical changes.

CONCLUSIONS

In general, obstetricians were more likely to select more aggressive therapy for women with premature contractions without changes in cervix. Since it is unlikely that patient preferences would influence the choice of strategies for preterm labor, it is likely that these results reflect true differences in physician practice patterns based on physician specialty.