Use and attitudes of obstetricians toward 3 high-risk interventions in MFMU Network hospitals

Abstract

OBJECTIVE We sought to evaluate the frequency of, and factors associated with, the use of 3 evidence-based interventions: antenatal corticosteroids for fetal lung maturity, progesterone for prevention of recurrent preterm birth, and magnesium sulfate for fetal neuroprotection. STUDY DESIGN A self-administered survey was conducted from January through May 2011 among obstetricians from 21 hospitals that included 30 questions regarding their knowledge, attitudes, and practice of the 3 evidence-based interventions and the 14-item short version of the Team Climate for Innovation survey. Frequency of use of each intervention was ascertained from an obstetrical cohort of women between January 2010 and February 2011. RESULTS A total of 329 obstetricians (74% response rate) who managed 16,946 deliveries within the obstetrical cohort participated in the survey. More than 90% of obstetricians reported that they incorporated each intervention into routine practice. Actual frequency of administration in women eligible for the treatments was 93% for corticosteroids, 39% for progesterone, and 71%formagnesiumsulfate. Provider satisfaction with quality of treatment evidence was 97% for corticosteroids, 82% for progesterone, and 57% for magnesium sulfate. Obstetricians perceived that barriers to treatment were most frequent for progesterone (76%), 30% for magnesium sulfate, and 17% for corticosteroids. Progesterone use was more frequent among patients whose provider reported the quality of the evidence was above average to excellent compared with poor to average (42% vs 25%, respectively; P < .001), and they were satisfied with their knowledge of the intervention (41%vs 28%; P = .02), and was less common among patients whose provider reported barriers to hospital or pharmacy drug delivery (31% vs 42%; P = .01). Corticosteroid administration was more common among patients who delivered at hospitals with 24 hours a day–7 days a week maternal-fetal medicine specialist coverage (93% vs 84%; P = .046), CONCLUSION Obstetricians in Maternal-Fetal Medicine Units Network hospitals frequently use these evidence-based interventions; however, progesterone usewas found to be related to their assessment of evidence quality. Neither progesterone nor the other interventions were associated with overall climate of innovation within a hospital as measured by the Team Climate for Innovation. National Institutes of Health Consensus Conference Statements may also have an impact on use; there is such a statement for antenatal corticosteroids but not for progesterone for preterm prevention or magnesium sulfate for fetal neuroprotection.

Pregnant women’s preferences for and concerns about preterm birth prevention: a cross-sectional survey

“…Although it may relate to the hypothetical nature of the scenario, it may also reflect respondents’ lack of understanding about the risks of preterm birth, which points to important opportunities for education. Alternatively, healthcare providers’ satisfaction with their knowledge and confidence in the quality of evidence for progesterone have been associated with its prescription [ 24 ]. Interestingly, patient characteristics do not consistently elicit its prescription, even for women visiting the same clinic [ 14 , 24 ].…”

“…A previous cross-sectional survey [ 15 ] and two chart review studies [ 16 , 17 ] focused on the acceptability of and concerns about progesterone. We identified one healthcare provider survey on cerclage [ 18 ], but most studies have focused on counselling practices on progesterone [ 15 , 18 – 24 ]. The need to consider women’s preferences is important because evidence has shown that most women reported greater satisfaction with their pregnancy when they were actively involved in medical decisions [ 25 ], and satisfaction, in turn, has been linked to increased confidence in their ability to take better care of themselves and their infants [ 26 ].…”

Pregnancy Outcomes in Women With a History of Previable, Preterm Prelabor Rupture of Membranes

“…Several recent reports have demonstrated 17-alpha hydroxyprogesterone caproate utilization among eligible women ranges from 39% to 47%. (28, 29). The reasons for our observed low utilization rate of 17-alpha hydroxyprogesterone caproate are unclear.…”

“…Due to the structure of healthcare delivery system in Utah, two-thirds of women delivering in the State of Utah are captured by our database, reducing the possibility that our data are biased towards worse outcomes and that individuals with subsequent healthy pregnancies would have received care and delivered elsewhere. 29 …”

Pregnancy Outcomes in Women With a History of Previable, Preterm Prelabor Rupture of Membranes: Correction

“…Due to the structure of healthcare delivery system in Utah, two-thirds of women delivering in the State of Utah are captured by our database, reducing the possibility that our data are biased towards worse outcomes and that individuals with subsequent healthy pregnancies would have received care and delivered elsewhere. 29 Because previable, preterm PROM is relatively uncommon, adequately powered RCTs of management strategies for future pregnancies are unlikely. Thus, consideration should be given to uterine cavity evaluation (with consideration of repair if an abnormality is found) and using evidence-based treatments extrapolated from more heterogeneous preterm birth intervention studies.…”