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German obstetrician's self-reported attitudes and handling in threatening preterm birth at the limits of viability

Katja Schneider1, Johanna Müller2, Ekkehard Schleußner2

  • 1Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany.

Journal of Perinatal Medicine
|May 31, 2023
PubMed

Insights

Obstetricians" approaches to threatened preterm birth vary, with joint counseling with neonatologists widely accepted. Parental autonomy in treatment decisions is crucial for initiating therapy for extremely premature infants.

Area of Science:

  • Perinatal Medicine
  • Medical Ethics
  • Obstetrics and Gynecology

Background:

  • Antenatal counseling and treatment significantly impact pregnancy outcomes and parental choices in cases of threatened prematurity.
  • Interprofessional differences exist in ethical decision-making at the limits of viability.

Purpose of the Study:

  • To evaluate the attitudes, practices, and antenatal parental counseling of German obstetricians regarding threatened preterm birth.
  • To understand decision-making processes for extremely premature infants at the borderline of viability.

Main Methods:

  • An anonymous online questionnaire was distributed to 543 obstetricians in Germany.
  • The survey included Likert scale questions on ethical issues and a case vignette concerning extreme preterm birth at 23 1/7 weeks gestation.

Main Results:

  • 15% of clinicians would perform a cesarean section for unstoppable preterm birth; specialists at high-volume very low birth weight centers were more likely to do so.
  • Nearly 30% required parental discussion before initiating therapy, while 20% declined to offer actionable advice.
  • 57% would advise parents to pursue intensive care, with flexibility for treatment changes, and 84% favored joint information delivery with neonatologists.

Conclusions:

  • Joint counseling with neonatologists is a widely accepted practice.
  • Perinatal center size influences the management of threatened preterm births.
  • Respecting parental autonomy in treatment decisions is fundamental to therapy initiation.
Abstract

Keywords:
borderline of viabilitydecision-makingethicsparental counselingperinatology

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