title: Do maternal characteristics influence maternal-fetal medicine physicians' willingness to intervene when managing periviable deliveries?
abstract: Determine the relative influence of patient characteristics on Maternal-Fetal Medicine (MFM) physicians' willingness to intervene when managing 23-week preterm premature rupture of membranes.
  
  
  
  Surveyed 750 randomly sampled US members of the Society of Maternal-Fetal Medicine. Physicians rated their willingness to offer induction, order steroids and perform cesarean across eight vignettes; then completed a questionnaire querying expectations about neonatal outcomes and demographics.
  
  
  
  Three hundred and twenty-five (43%) MFMs responded. Patient characteristics only influenced ⩽11% of participants' willingness ratings. Overall, provider characteristics and institutional norms were associated with willingness to perform antenatal interventions, for example, practice region was associated with willingness to offer induction (P<0.001), order steroids (P=0.008) and perform cesarean for distress (P=0.011); while institutional cesarean cutoffs were associated with willingness to order steroids and perform cesarean for labor and distress (all P<0.001).
  
  
  
  Physician-level factors and institutional norms, more so than patient characteristics, may drive periviable care and outcomes.
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: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Robinson
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
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008875:Middle Aged; D009035:Mothers; D009774:Obstetrics; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012067:Religion; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D014481:United States