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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: B Tucker
authors.initials: BT
authors.lastname: Edmonds
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: F
authors.initials: F
authors.lastname: McKenzie
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Hendrix
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Perkins
authors.affiliation: Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Zimet
mesh_terms: D000328:Adult; D000368:Aged; D002585:Cesarean Section; D003657:Decision Making; D005260:Female; D005328:Fetal Viability; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D057240:Patient Preference; D010820:Physicians; D012151:Resuscitation