Maternal-Fetal Medicine physicians' practice patterns for 22-week delivery management

Area of Science:

• Maternal-Fetal Medicine
• Perinatal Care
• Obstetrics

Background:

• Management of preterm premature rupture of membranes (PPROM) at 22 weeks presents complex ethical and clinical challenges.
• Practices among Maternal-Fetal Medicine (MFM) physicians for 22-week delivery management are not well-documented.

Purpose of the Study:

• To describe the practice patterns of Maternal-Fetal Medicine (MFM) physicians regarding delivery management at 22 weeks gestation.
• To identify factors influencing MFM physicians' decisions for 22-week delivery interventions.

Main Methods:

• A survey was distributed to 750 randomly selected members of the Society of Maternal-Fetal Medicine.
• The survey queried MFM physicians' current practices and policies for managing 22-week deliveries.

Main Results:

• Of 325 respondents (43% response rate), 87% would offer induction of labor.
• Twenty-eight percent would order steroids, and 12% would perform cesarean delivery for patients desiring resuscitation.
• Offering induction varied significantly by practice setting, region, religious attendance, and political affiliation, with political affiliation remaining a significant predictor in multivariable analysis.

Conclusions:

• The majority of MFMs offer induction for PPROM at 22 weeks.
• A notable percentage of MFMs consider or offer interventions like steroids or cesarean delivery.
• Provider beliefs and practice characteristics appear to influence management decisions at this early gestational age.