The influence of resuscitation preferences on obstetrical management of periviable deliveries

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9 Citations (Scopus)

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.Journal of Perinatology advance online publication, 25 September 2014; doi:10.1038/jp.2014.175.

Original languageEnglish
JournalJournal of Perinatology
DOIs
StateAccepted/In press - Sep 25 2014

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Resuscitation
Patient Preference
Gestational Age
Physicians
Decision Making
Steroids
Perinatology
Occupations
Publications

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

Cite this

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title = "The influence of resuscitation preferences on obstetrical management of periviable deliveries",
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.Journal of Perinatology advance online publication, 25 September 2014; doi:10.1038/jp.2014.175.",
author = "{Tucker Edmonds}, Brownsne and F. McKenzie and Hendrix, {K. S.} and Susan Perkins and Gregory Zimet",
year = "2014",
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language = "English",
journal = "Journal of Perinatology",
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AU - McKenzie, F.

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AU - Perkins, Susan

AU - Zimet, Gregory

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N2 - 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.Journal of Perinatology advance online publication, 25 September 2014; doi:10.1038/jp.2014.175.

AB - 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.Journal of Perinatology advance online publication, 25 September 2014; doi:10.1038/jp.2014.175.

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