Practice variation in late-preterm deliveries: a physician survey

Late-preterm (LPT) neonates account for over 70% of all preterm births in the US. Approximately 60% of LPT births are the result of non-spontaneous deliveries. The optimal timing of delivery for many obstetric conditions at LPT gestations is unclear, likely resulting in obstetric practice variation. The purpose of this study is to identify variation in the obstetrical management of LPT pregnancies.

We surveyed obstetrical providers in North Carolina identified from North Carolina Medical Board and North Carolina Obstetrical and Gynecological Society membership lists. Participants answered demographic questions and six multiple-choice vignettes on management of LPT pregnancies.

We obtained 215/859 (29%) completed surveys which are as follows: 167 (78%) from obstetrics/gynecology, 27 (13%) from maternal-fetal medicine, and 21 (10%) from family medicine physicians. Overall, we found more agreement on respondents' management of chorioamnionitis (97% would proceed with delivery), mild pre-eclampsia (84% would delay delivery/expectantly manage) and fetal growth restriction (FGR) (80% would delay delivery/expectantly manage). We found less agreement on the management of severe preeclampsia (71% would proceed with delivery), premature preterm rupture of membranes (69% would proceed with delivery) and placenta previa (67% would delay delivery/expectantly manage). Management of LPT pregnancies complicated by preterm premature rupture of membranes, FGR and placenta previa vary by specialty.

Obstetrical providers report practice variation in the management of LPT pregnancies. Variation might be influenced by provider specialty. The absence of widespread agreement on best practice might be a source of modifiable LPT birth.