Offering induction of labor for 22-week premature rupture of membranes: a survey of obstetricians.
OBJECTIVE
To describe obstetricians' induction counseling practices for 22-week preterm premature rupture of membranes (PPROM) and identify provider characteristics associated with offering induction.


METHODS
Surveyed 295 obstetricians on their likelihood (0-10) of offering induction for periviable PPROM across 10 vignettes. Twenty-two-week vignettes were analyzed, stratified by parental resuscitation preference. Bivariate analyses identified physician characteristics associated with reported likelihood ratings.


RESULTS
Obstetricians (N=205) were not likely to offer induction. Median ratings by preference were as follows: resuscitation 1.0, uncertain 1.0 and comfort care 3.0. Only 41% of obstetricians were likely to offer induction to patients desiring comfort care. In addition, several provider-level factors, including practice region, parenting status and years in practice, were significantly associated with offering induction.


CONCLUSIONS
Obstetricians do not readily offer induction when counseling patients with 22-week ruptured membranes, even when patients prefer palliation. This may place women at risk for infectious complications without accruing a neonatal benefit from prolonged latency.
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
F
F
McKenzie
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
B
B
Tucker Edmonds
D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007751:Labor, Induced / Q000145:classification*; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D010820:Physicians / Q000706:statistics & numerical data*; D011247:Pregnancy; D047928:Premature Birth; D011795:Surveys and Questionnaires