Maternal-Fetal Medicine Subspecialists' Provision of Second-Trimester Termination Services

Jennifer L. Kerns; Jody E. Steinauer; Melissa G. Rosenstein; Jema K. Turk; Aaron B. Caughey; Mary D'Alton

doi:10.1055/s-0032-1314893

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2012; 29(09): 709-716
DOI: 10.1055/s-0032-1314893

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal-Fetal Medicine Subspecialists' Provision of Second-Trimester Termination Services

Jennifer L. Kerns

¹Division of San Francisco General Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

,

Jody E. Steinauer

¹Division of San Francisco General Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

,

Melissa G. Rosenstein

¹Division of San Francisco General Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

,

Jema K. Turk

¹Division of San Francisco General Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

,

Aaron B. Caughey

²Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

,

Mary D'Alton

³Department of Obstetrics and Gynecology, Columbia University, New York, New York

› Institutsangaben

Abstract

Objective Most abortions for pregnancy complications occur in the second trimester. Little is known about whether maternal-fetal medicine subspecialists (MFMs) perform terminations for these women.

Study Design We surveyed all members of Society of Maternal Fetal Medicine by e-mail or mail regarding second-trimester abortion provision. We conducted analyses of whether MFMs perform abortions, by what method, and how frequently.

Results Our response rate was 32.4% (689/2,125). Over two-thirds of respondents perform either dilation and evacuation (D&E) or induction; 31% perform D&Es. Male gender, frequent chorionic villus sampling provision, and being trained in D&E during fellowship are associated with performing D&Es. Nonprovision of any second-trimester abortion is significantly associated with age over 50, nonacademic practice setting, and less supportive abortion attitudes (p < 0.001). A nonsignificant trend toward association between south/southeast region and nonprovision of any second-trimester abortion is seen (p = 0.09).

Conclusion Many MFMs include D&E and induction termination services in their practice. Supporting current D&E providers and expanding training options for MFMs may optimize care for women diagnosed with serious pregnancy complications.

Keywords

fetal anomalies - fetal demise - pregnancy complications - termination of pregnancy

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Referenzen

References
1 Practice Bulletin ACOG ; ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol 2007; 109: 217-227
2 Anderson N, Boswell O, Duff G. Prenatal sonography for the detection of fetal anomalies: results of a prospective study and comparison with prior series. AJR Am J Roentgenol 1995; 165: 943-950
3 Boyd PA, Devigan C, Khoshnood B, Loane M, Garne E, Dolk H ; EUROCAT Working Group. Survey of prenatal screening policies in Europe for structural malformations and chromosome anomalies, and their impact on detection and termination rates for neural tube defects and Down's syndrome. BJOG 2008; 115: 689-696
4 Shaffer BL, Caughey AB, Norton ME. Variation in the decision to terminate pregnancy in the setting of fetal aneuploidy. Prenat Diagn 2006; 26: 667-671
5 Liu S, Joseph KS, Kramer MS , et al; Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada. JAMA 2002; 287: 1561-1567
6 Wyldes MP, Tonks AM. Termination of pregnancy for fetal anomaly: a population-based study 1995 to 2004. BJOG 2007; 114: 639-642
7 Jones RK, Kooistra K. Abortion incidence and access to services in the United States, 2008. Perspect Sex Reprod Health 2011; 43: 41-50
8 Pazol K, Zane S, Parker WY , et al; Centers for Disease Control and Prevention (CDC). Abortion surveillance—United States, 2007. MMWR Surveill Summ 2011; 60: 1-42
9 Hammond C. Recent advances in second-trimester abortion: an evidence-based review. Am J Obstet Gynecol 2009; 200: 347-356
10 Jones RK, Kavanaugh ML. Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion. Obstet Gynecol 2011; 117: 1358-1366
11 Lohr PA, Hayes JL, Gemzell-Danielsson K. Surgical versus medical methods for second trimester induced abortion. Cochrane Database Syst Rev 2008; (1) CD006714
12 Edlow AG, Hou MY, Maurer R, Benson C, Delli-Bovi L, Goldberg AB. Uterine evacuation for second-trimester fetal death and maternal morbidity. Obstet Gynecol 2011; 117 (2 Pt 1) 307-316
13 Autry AM, Hayes EC, Jacobson GF, Kirby RS. A comparison of medical induction and dilation and evacuation for second-trimester abortion. Am J Obstet Gynecol 2002; 187: 393-397
14 Bryant AG, Grimes DA, Garrett JM, Stuart GS. Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation. Obstet Gynecol 2011; 117: 788-792
15 Cowett AA, Golub RM, Grobman WA. Cost-effectiveness of dilation and evacuation versus the induction of labor for second-trimester pregnancy termination. Am J Obstet Gynecol 2006; 194: 768-773
16 Jones RK, Zolna MR, Henshaw SK, Finer LB. Abortion in the United States: incidence and access to services, 2005. Perspect Sex Reprod Health 2008; 40: 6-16
17 Ogunyemi D, Buskye S. Prenatal diagnosis of fetal anomalies in a regional tertiary center: the role of a maternal fetal medicine unit—a review of 6,877 deliveries. J Matern Fetal Med 2000; 9: 219-223
18 Lalor JG, Devane D, Begley CM. Unexpected diagnosis of fetal abnormality: women's encounters with caregivers. Birth 2007; 34: 80-88
19 Korenromp MJ, Page-Christiaens GC, van den Bout J, Mulder EJ, Visser GH. Maternal decision to terminate pregnancy in case of Down syndrome. Am J Obstet Gynecol 2007; 196: 149 , e1–e11
20 Aiyer AN, Ruiz G, Steinman A, Ho GY. Influence of physician attitudes on willingness to perform abortion. Obstet Gynecol 1999; 93: 576-580
21 Hoge D. A validated intrinsic religious motivation scale. J Sci Study Relig 1972; 11: 369-376
22 Coustan DR, Schwartz RM, Gagnon DE, VanDorsten JP ; Society for Maternal-Fetal Medicine. The distribution, practice, and attitudes of maternal-fetal medicine specialists. Am J Obstet Gynecol 2001; 185: 1218-1225
23 Rubin A. Americans Narrowing Support for Abortions. Los Angeles Times; June 18, 2000;
24 Steinauer J, Landy U, Filippone H, Laube D, Darney PD, Jackson RA. Predictors of abortion provision among practicing obstetrician-gynecologists: a national survey. Am J Obstet Gynecol 2008; 198: 39 , e1–e6
25 Steinauer JE, Landy U, Jackson RA, Darney PD. The effect of training on the provision of elective abortion: a survey of five residency programs. Am J Obstet Gynecol 2003; 188: 1161-1163
26 Allen RH, Raker C, Steinauer J, Eastwood KL, Kacmar JE, Boardman LA. Future abortion provision among US graduating obstetrics and gynecology residents, 2004. Contraception 2010; 81: 531-536
27 Doss AE, Davidson JD, Cliver SP , et al. Antibiotic prophylaxis for cesarean delivery: survey of maternal-fetal medicine physicians in the US. J Matern Fetal Neonatal Med 2011; ; July 18 [Epub ahead of print]
28 Fox NS, Gelber SE, Kalish RB, Chasen ST. Contemporary practice patterns and beliefs regarding tocolysis among U.S. maternal-fetal medicine specialists. Obstet Gynecol 2008; 112: 42-47
29 Schwartz N, Sweeting R, Young BK. Practice patterns in the management of isolated oligohydramnios: a survey of perinatologists. J Matern Fetal Neonatal Med 2009; 22: 357-361
30 ACGME Program Requirements for Graduate Medical Education in Obstetrics and Gynecology, June 1, 2008. Section IV.A.2.d. 31 pages. www.acgme.org/acWebsite/RRC_220/220_prIndex.asp
31 Kerns J, Vanjani R, Freedman L, Meckstroth K, Drey EA, Steinauer J. Women's decision making regarding choice of second trimester termination method for pregnancy complications. Int J Gynaecol Obstet 2012; 116: 244-248