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Patient Preferences a Factor in Premature Birth Options

Counseling on the risks and management of periviable deliveries influenced by patient wishes

MONDAY, March 5 (HealthDay News) -- Obstetric decisions in managing and counseling for periviable deliveries are heavily influenced by patient preference and perspectives on patient autonomy, according to a study published in the March issue of the American Journal of Obstetrics & Gynecology.

To examine factors influencing obstetric decision-making and counseling for patients with high-risk periviable neonates, Brownsyne Tucker Edmonds, M.D., M.P.H., of the University of Pennsylvania in Philadelphia, and associates conducted 21 in-depth interviews with obstetricians from several Philadelphia hospitals that offer labor and delivery services.

The researchers found that patient preferences had a strong influence on obstetric decision-making and counseling. They further discovered that most institutions had no formal clinical standards for periviable care or managing premature deliveries between 22 and 26 weeks, which resulted in a wide variation in practices.

"The impact of institutional variation and in vitro fertilization on periviable decision-making warrants further consideration," the authors write. "Interventions to train and support obstetricians in communicating uncertainty, managing expectations, and assessing values and understanding are needed."

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