title: Comparing obstetricians' and neonatologists' approaches to periviable counseling.
abstract: OBJECTIVE
  To compare the management options, risks and thematic content that obstetricians and neonatologists discuss in periviable counseling.
  
  
  METHODS
  Sixteen obstetricians and 15 neonatologists counseled simulated patients portraying a pregnant woman with ruptured membranes at 23 weeks of gestation. Transcripts from video-recorded encounters were qualitatively and quantitatively analyzed for informational content and decision-making themes.
  
  
  RESULTS
  Obstetricians more frequently discussed antibiotics (P=0.005), maternal risks (<0.001) and cesarean risks (<0.005). Neonatologists more frequently discussed neonatal complications (P=0.044), resuscitation (P=0.015) and palliative options (P=0.023). Obstetricians and neonatologists often deferred questions about steroid administration to the other specialty. Both specialties organized decision making around medical information, survival, quality of life, time and support. Neonatologists also introduced themes of values, comfort or suffering, and uncertainty.
  
  
  CONCLUSIONS
  Obstetricians and neonatologists provided complementary counseling content to patients, yet neither specialty took ownership of steroid discussions. Joint counseling and/or family meetings may minimize observed redundancy and inconsistencies in counseling.
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: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Panoch
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Barnato
authors.affiliation: Mary Margaret Walther Center for Research and Education in Palliative Care, IU Simon Cancer Center, Indianapolis, IN, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Frankel
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling; D003657:Decision Making; D005260:Female; D005328:Fetal Viability; D005865:Gestational Age; D006801:Humans; D008297:Male; D008875:Middle Aged; D009359:Neonatology; D009774:Obstetrics; D010820:Physicians / Q000706:statistics & numerical data*; D011788:Quality of Life; D014741:Video Recording