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The influence of resuscitation preferences on obstetrical management of periviable deliveries

Journal of Perinatology volume 35, pages 161–166 (2015)Cite this article

Subjects

Abstract

Objective:

To determine the relative influence of patients’ resuscitation preferences on periviable delivery management.

Study Design:

Surveyed 295 obstetrician-gynecologists about managing periviable preterm premature rupture of membranes. Across 10 vignettes, we systematically varied gestational age, occupation, method of conception and resuscitation preference. Physicians rated their likelihood (0 to 10) of proceeding with induction, steroids and cesarean. Data were analyzed via conjoint analysis.

Result:

Two hundred and five physician responses were included. Median ratings for management decisions were: induction 1.89; steroids 5.00; cesarean for labor 3.89; and cesarean for distress 4.11. Gestational age had the greatest influence on physician ratings across all decisions (importance values ranging from 72.6 to 86.6), followed by patient’s resuscitation preference (range=9.3 to 21.4).

Conclusion:

Gestational age is weighted more heavily than patients’ resuscitation preferences in obstetricians’ decision making for periviable delivery management. Misalignment of antenatal management with parental resuscitation preferences may adversely affect periviable outcomes. Interventions are needed to facilitate more patient-centered decision making in periviable care.

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Acknowledgements

This publication was made possible in part by Grant Number KL2 TR000163 (A Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA,

    B Tucker Edmonds & F McKenzie

  2. Department of Pediatrics, Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA,

    K S Hendrix

  3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA,

    S M Perkins

  4. Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA,

    G D Zimet

Authors
  1. B Tucker Edmonds
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  2. F McKenzie
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  3. K S Hendrix
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  4. S M Perkins
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  5. G D Zimet
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Corresponding author

Correspondence to B Tucker Edmonds.

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The authors declare no conflict of interest.

Appendix A

Appendix A

Vignette

The patient is a 32-year-old {Black OR White} G1P0 now at [GA+] who presents to L&D with confirmed preterm premature rupture of membranes (PPROMs). Her medical, surgical and family histories are negative. She denies tobacco, alcohol or drug use, and she [Occupation]. This pregnancy was the result of [Fertility History]. The pregnancy has been uncomplicated. Her prenatal labs, quad screen and anatomy scan were all normal. She is not contracting or dilated. Her exam is negative for vaginal bleeding and shows no signs of infection. Fetal status is reassuring. Today’s ultrasound reveals a female fetus in breech presentation with an EFW of [+EFW] and an AFI of 5.1. The patient has been counseled by the neonatal intensive care unit [resuscitation preference].

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Tucker Edmonds, B., McKenzie, F., Hendrix, K. et al. The influence of resuscitation preferences on obstetrical management of periviable deliveries. J Perinatol 35, 161–166 (2015). https://doi.org/10.1038/jp.2014.175

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