A national survey of obstetricians' attitudes toward and practice of periviable intervention

Edmonds, Brownsyne Tucker; McKenzie, Fatima; Farrow, Victoria A.; Raglan, Greta B.; Schulkin, Jay

doi:10.1038/jp.2014.201

Cited by 18 publications

(19 citation statements)

References 20 publications

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“…The personal lower limit for certain treatment decisions associated with prematurity varied up to 4 weeks between individuals. It is known that personal preferences can influence counseling and decision-making [ 34 ]. For the interventions covered in the Dutch guideline, our results are fairly consistent with the guideline recommendations (transfer to a tertiary center at 23 +4/7 weeks GA and administration of corticosteroids at 23 +5/7 weeks GA).…”

Section: Discussionmentioning

confidence: 99%

“…Participants indicated 25 +0/7 weeks of GA as median lower limit, with a wide variation. Tucker Edmonds recently showed that obstetricians had a personal cutoff for performing a CS at a later GA (median 25 +0/7 weeks GA) than the institutional cutoff (median 24 +0/7 weeks GA) [ 34 ]. Having a neonatologist present at delivery and intubation after birth when necessary both showed a median lower limit at 24 +0/7 weeks of gestation, with relatively little variation; probably because these two items are seen as the minimum conditions that must be met when offering intensive care at 24 +0/7 weeks (and implicitly covered in our guideline).…”

Section: Discussionmentioning

confidence: 99%

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Perinatal practice in extreme premature delivery: variation in Dutch physicians’ preferences despite guideline

Geurtzen¹,

Draaisma²,

Hermens

et al. 2016

Eur J Pediatr

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Decisions at the limits of viability about initiating care are challenging. We aimed to investigate physicians’ preferences on treatment decisions, against the background of the 2010 Dutch guideline offering active care from 24+0/7 weeks of gestational age (GA). Obstetricians’ and neonatologists’ opinions were compared. An online survey was conducted amongst all perinatal professionals (n = 205) of the 10 Dutch level III perinatal care centers. Response rate was 60 % (n = 122). Comfort care was mostly recommended below 24+0/7 weeks and intensive care over 26+0/7 weeks. The professional views varied most at 24 and 25 weeks, with intensive care recommended but comfort care at parental request optional being the median. There was a wide range in perceived lowest limits of GA for interventions as a caesarian section and a neonatologist present at birth. Obstetricians and neonatologists disagreed on the lowest limit providing chest compressions and administering epinephrine for resuscitation. The main factors restricting active treatment were presence of congenital disorders, “small for gestational age” fetus, and incomplete course of corticosteroids.Conclusion: There was a wide variety in individually preferred treatment decisions, especially when aspects were not covered in the Dutch guideline on perinatal practice in extreme prematurity. Furthermore, obstetricians and neonatologists did not always agree. What is known: • Cross-cultural differences exists in the preferred treatment at the limits of viability • In the Netherlands since 2010, intensive care can be offered starting at 24 +0/7 weeks gestation What is new: • There was a wide variety in preferred treatment decisions at the limits of viability especially when aspects were not covered in the Dutch national guideline on perinatal practice in extreme prematurity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perinatal practice in extreme premature delivery: variation in Dutch physicians’ preferences despite guideline

Geurtzen¹,

Draaisma²,

Hermens

et al. 2016

Eur J Pediatr

View full text Add to dashboard Cite

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“…Respondents reported institutional cutoffs of 23 weeks for resuscitation (34%) and 24 weeks for Cesarean sections (35%). At 23 weeks, two thirds ordered steroids, 43% recommended Cesarean section and 23% offered induction 12 . This lack of agreement is confirmed by a recent report 13 on practices and education surrounding anticipated periviable deliveries.…”

Section: Discussionmentioning

confidence: 99%

The Mortality of Periviable and Extremely Premature Infants and Their Impact on the Overall Neonatal Mortality Rate

Falciglia

Merkel

Glover

et al. 2020

Sci Rep

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to investigate mortality in periviable neonates ≤23 weeks gestational age and calculate its impact on overall neonatal mortality rate over a 12-year period (1998-2009). Verify if periviable mortality decreased in the period (2010-2015). Retrospective review. Neonatal mortality rate per 1000 live births was 11.4. Three hundred forty-nine live birth infants weighed ≤500 g and 336 died. Their proportion to the total neonatal mortality rate was 48.6%; out of 298 periviables 146 (43%) were ≤20 weeks gestational age. In 269 (80%) we could not determine the cause of death. Two hundred ninety-seven neonates (88.3%) died in the delivery room. Sixteen (5%) had an autopsy. Neonatal mortality rate from periviability was 96. 2% and constituted half of the overall rate in the period (1998-2009). There was not significant reduction of periviable mortality between 2010 and 2015. Current live birth definition and a reporting system that considers a 100 g periviable live birth infant as a neonatal death has placed Ohio and the United States at a significant disadvantage compared to other countries using different reporting systems.

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“…Our previous work has shown that nearly one third of generalists manage periviable deliveries without input from MFM consultants, which may especially be the case at 22 weeks. 21 Future studies should, however, include a larger MFM sample in order to capture the practices of the specialists with the greatest impact on periviable care. Furthermore, this study did not include neonatologists, whose responses may differ due to the availability of the online Neonatal Outcome Data, which may facilitate pediatric decision-making in this setting.…”

Section: Discussionmentioning

confidence: 99%

Offering induction of labor for 22-week premature rupture of membranes: a survey of obstetricians

McKenzie

Edmonds

2015

J Perinatol

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Objective To describe obstetricians’ induction counseling practices for 22-week preterm premature rupture of membranes (PPROM) and identify provider characteristics associated with offering induction. Methods Surveyed 295 obstetricians on their likelihood (0–10) of offering induction for periviable PPROM across 10 vignettes. 22-week vignettes were analyzed, stratified by parental resuscitation preference. Bivariate analyses identified physician characteristics associated with reported likelihood ratings. Results Obstetricians (N=205) were not likely to offer induction. Median ratings by preference were: resuscitation 1.0, uncertain 1.0, and comfort care 3.0. Only 41% of obstetricians were likely to offer induction to patients desiring comfort care. Additionally, several provider-level factors, including practice region, parenting status, and years in practice, were significantly associated with offering induction. Conclusions Obstetricians do not readily offer induction when counseling patients with 22-week ruptured membranes, even when patients prefer palliation. This may place women at risk for infectious complications without accruing a neonatal benefit from prolonged latency.

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A national survey of obstetricians' attitudes toward and practice of periviable intervention

Abstract: OBs' willingness to intervene can impact periviable outcomes. These findings suggest that personal and institutional factors may influence obstetrical counseling and decision-making.

Cited by 18 publications

References 20 publications

Perinatal practice in extreme premature delivery: variation in Dutch physicians’ preferences despite guideline

Perinatal practice in extreme premature delivery: variation in Dutch physicians’ preferences despite guideline

The Mortality of Periviable and Extremely Premature Infants and Their Impact on the Overall Neonatal Mortality Rate

Offering induction of labor for 22-week premature rupture of membranes: a survey of obstetricians

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