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Published on: January 27, 2023
Practice variation in late-preterm deliveries: a physician survey
S Aliaga1, W Price, M McCaffrey
1Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA. saliaga@med.unc.edu
Summary
Obstetric providers show significant practice variation in managing late-preterm (LPT) pregnancies. This variation, particularly in conditions like preterm premature rupture of membranes, may stem from provider specialty and impact LPT birth outcomes.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Healthcare Management
Background:
- Late-preterm (LPT) neonates constitute over 70% of US preterm births.
- A majority of LPT births result from non-spontaneous deliveries.
- Optimal delivery timing for LPT gestations with various obstetric conditions remains unclear, leading to practice variability.
Purpose of the Study:
- To identify and characterize variations in the obstetrical management of LPT pregnancies.
- To explore potential influences on practice variation in LPT pregnancy management.
Main Methods:
- A survey was distributed to obstetrical providers in North Carolina.
- Participants included physicians from obstetrics/gynecology, maternal-fetal medicine, and family medicine.
- The survey comprised demographic questions and six multiple-choice vignettes on LPT pregnancy management.
Main Results:
- A response rate of 29% (215/859) was achieved.
- High agreement was observed in managing chorioamnionitis (97%), mild pre-eclampsia (84%), and fetal growth restriction (FGR) (80%).
- Lower agreement was found for severe pre-eclampsia (71%), premature preterm rupture of membranes (PPROM) (69%), and placenta previa (67%).
- Management of LPT pregnancies with PPROM, FGR, and placenta previa showed variation by provider specialty.
Conclusions:
- Obstetric providers report considerable practice variation in managing LPT pregnancies.
- Provider specialty appears to be a potential influencing factor in this variation.
- Lack of consensus on best practices may contribute to modifiable LPT births.
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