title: Survey of obstetricians' personal preference and discretionary practice.
abstract: OBJECTIVE
  To determine obstetricians personal choices in relation to Down syndrome screening and mode of delivery for themselves or their partners.
  
  
  METHODS
  Structured anonymous postal survey. All 282 obstetric consultants, senior registrars and registrars in NHS obstetric units within London's M25 region were surveyed.
  
  
  RESULTS
  The response rate was 73% (206). Fifty one per cent (105) chose to have elective amniocentesis/CVS without a previous screening test when maternal age was > or = 35 years and 11% (23) when < 35 years. Of the remainder, the majority wanted both maternal serum screening and nuchal translucency rather than a single screening test. In relation to mode of delivery, 17% (33) of obstetricians chose elective caesarean section (CS) in the absence of any clinical indication. Of those who chose CS, 88% did so out of fear of perineal damage. However when faced with a mid-cavity instrumental delivery in the second stage, only 5% (8) wanted CS, the remainder choosing operative vaginal delivery. With an uncomplicated breech presentation, only 27% (55) opted for external cephalic version while 57% (114) chose elective CS.
  
  
  CONCLUSIONS
  This study demonstrates interventionist attitudes among a sizeable percentage of obstetricians in relation to antenatal screening and their own preferred mode of delivery. It suggests that obstetricians regard management options not normally available to pregnant women as valid choices for themselves or their partners.
authors.affiliation: Royal Postgraduate Medical School, Institute of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Al-Mufti
authors.forename: A
authors.initials: A
authors.lastname: McCarthy
authors.forename: N M
authors.initials: NM
authors.lastname: Fisk
mesh_terms: D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D004314:Down Syndrome; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D009774:Obstetrics / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011795:Surveys and Questionnaires