title: A national survey of obstetricians' attitudes toward and practice of periviable intervention.
abstract: OBJECTIVE
  Test the association between provider characteristics and antenatal interventions offered for periviable delivery.
  
  
  METHODS
  Six hundred surveys mailed to members of the College's Collaborative Ambulatory Research Network. Items queried physicians' practices regarding administering steroids, recommending cesarean (for breech) and offering induction (for ruptured membranes) at 23 weeks.
  
  
  RESULTS
  Three hundred and ten (52%) obstetricians (OBs) responded. Respondents reported institutional cutoffs of 23 weeks for resuscitation (34%) and 24 weeks for cesarean (35%), whereas personal preferences for cesarean were ⩾25 weeks (44%). At 23 weeks, two-thirds ordered steroids, 43% recommended cesarean and 23% offered induction. In multivariable analyses, institutional cutoffs and providers' personal preferences predicted steroid administration (odds ratio, OR=4.37; 95% confidence interval, CI=1.73 to 11.00; OR=0.30, 95% CI=0.13 to 0.70); institutional cutoffs and the impression that cesarean decreases neurodevelopmental disability predicted recommending cesarean (OR=3.09, 95% CI=1.13 to 8.44; OR=6.41, 95% CI=2.06 to 19.91). For offering induction, practice location and religious service attendance approached, but did not meet, statistical significance (P=0.06 and P=0.05).
  
  
  CONCLUSIONS
  OBs' willingness to intervene can impact periviable outcomes. These findings suggest that personal and institutional factors may influence obstetrical counseling and decision-making.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: B
authors.initials: B
authors.lastname: Tucker 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: 1] Research Department, American College of Obstetricians and Gynecologists, Washington, DC, USA [2] Department of Psychology, American University, Washington, DC, USA.
authors.forename: V
authors.initials: V
authors.lastname: Farrow
authors.affiliation: 1] Research Department, American College of Obstetricians and Gynecologists, Washington, DC, USA [2] Department of Psychology, American University, Washington, DC, USA.
authors.forename: G
authors.initials: G
authors.lastname: Raglan
authors.affiliation: Research Department, American College of Obstetricians and Gynecologists, Washington, DC, USA.
authors.forename: J
authors.initials: J
authors.lastname: Schulkin
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D005328:Fetal Viability; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009774:Obstetrics / Q000379:methods; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires