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Family preferences strongly influence decision making in very premature deliveries
Date:3/1/2012

Philadelphia, PA, March 2, 2012 When making decisions and counseling about risk and management options for deliveries between 22 and 26 weeks (periviable deliveries), obstetricians are heavily influenced by family preferences, particularly by the impression that parents consistently prefer to have everything possible done to prolong a pregnancy or "save the baby" through interventions such as cesarean section. The results of a University of Pennsylvania study are published in the March issue of the American Journal of Obstetrics and Gynecology.

Periviable neonates bear the greatest burden of neonatal death and illness. As many as one half of the babies do not survive, and half of those who do survive experience moderate to severe neurologic disability. How these cases are obstetrically managed can influence neonatal outcomes. A previous study found that obstetricians' willingness to perform cesarean delivery at 24 weeks increased the odds of survival 3.7 times, but doubled the chance of survival with serious morbidity.

In the current study investigators conducted structured interviews of 21 obstetricians at academic medical centers in Philadelphia. Respondents were asked to describe their typical approach to managing periviable delivery, and the patient, institutional, and personal factors that influence their clinical decision making. They were also asked about their approach to counseling patients, and what challenges they faced in doing so.

The authors found that, although circumscribed by institutional norms, obstetric decision making and counseling for periviable deliveries were influenced primarily by patient preference, clinical presentation, and perspectives on patient autonomy. Most institutions had no formal policies to dictate practice standards for periviable care, and study participants described a considerable amount of variation in practice. Even within the same institution, thresholds vary for what w
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Contact: Francesca Costanzo
ajogmedia@elsevier.com
215-239-3249
Elsevier Health Sciences
Source:Eurekalert

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