Induction of Labor for Maternal Indications at a Periviable Gestational Age; Survey on Management, Reporting and Auditing amongst Dutch Maternal-Fetal Medicine Specialists and Neonatologists

Abstract

Background In cases of life-threatening maternal conditions in the periviable period, professionals may consider immediate delivery with fetal demise as a consequence of the treatment. We sought the opinion of involved medical professionals on management, reporting, and auditing in these cases.

Methods We performed an online survey amongst all registered maternal-fetal medicine (MFM) specialists and neonatologists in the Netherlands. The survey presented two hypothetical cases of severe early-onset pre-eclampsia at periviable gestational ages. Management consisted of immediate termination or expectant management directed towards newborn survival.

Findings In the case managed by immediate termination, 62% percent answered that fetal demise resulting from induction of labor for maternal indications should be audited only within the medical profession. In the case of expectant management, 17% of the participants agreed with this management. Some answers revealed a significant difference in opinion between the medical specialists.

Conclusion Perspective of MFM specialists and neonatologists differs with regard to counseling prospect parents in case of severe early onset pre-eclampsia. The majority of professionals is willing to report late termination (after 24 weeks' gestation) for severe maternal disease to medical experts for internal audits but not for legal auditing.

Keywords

termination of pregnancy - legislation - survey - MFM specialists - neonatologists

• References

• 1 Wetboek online. Available from: www.wetboek-online.nl/wet/Sr/82a.htlm; accessed September 25, 2018
• 2 Jaarrapportage 2014 van de Wet afbreking zwangerschap. Inspectie voor de Gezondheidszorg, Ministerie van Volksgezondheid, Welzijn en Sport. Available from: www.igz.nl . Accessed October 15, 2015
• 3 www.wetten.overheid.nl/wet_op_de_lijkbezorging ; accessed September 25, 2018
• 4 NVOG modelprotocol LZA: Medisch handelen late zwangerschapsafbreking 2007
• 5 Regeling beoordelingscommissie late zwangerschapsafbreking en levensbeëindiging bij pasgeborenen. Staatcourant, nr 3145, 26–01–2016. Available from: www.wetten.overheid.nl/BWBR0037570 . Accessed September 25, 2018
• 6 van Eerden L, Zeeman GG, Page-Christiaens GC. , et al. Termination of pregnancy for maternal indications at the limits of fetal viability: a retrospective cohort study in the Dutch tertiary care centres. BMJ Open 2014; 4 (06) e005145
• 7 www.wetten.overheid.nl/wet_medisch_wetenschappelijk_onderzoek_met_mensen ; accessed September 25, 2018
• 8 Belghiti J, Kayem G, Tsatsaris V, Goffinet F, Sibai BM, Haddad B. Benefits and risks of expectant management of severe preeclampsia at less than 26 weeks gestation: the impact of gestational age and severe fetal growth restriction. Am J Obstet Gynecol 2011; 205 (05) 465.e1-465.e6
• 9 Schutte JM, Steegers EA, Schuitemaker NW. , et al; Netherlands Maternal Mortality Committee. Rise in maternal mortality in the Netherlands. BJOG 2010; 117 (04) 399-406
• 10 Maternal, Newborn and Infant Clinical Outcome Review Programme. Saving lives, improving mothers' care lessons: learned to inform future maternity care from the uk and ireland confidential enquiries into maternal deaths and morbidity 2009–2012. Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk, JJ, eds. Available from: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf ; accessed September 25, 2018
• 11 Reddy UM, Rice MM, Grobman WA. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Serious maternal complications after early preterm delivery (24-33 weeks' gestation). Am J Obstet Gynecol 2015; 213 (04) 538.e1-538.e9
• 12 Lannon SMR, Guthrie KA, Vanderhoeven JP, Gammill HS. Uterine rupture risk after periviable cesarean delivery. Obstet Gynecol 2015; 125 (05) 1095-1100
• 13 Nederlandse richtlijn perinataal beleid bij extreme vroeggeboorte 2010. www.nvog-documenten.nl/index.php . Accessed October 22, 2018
• 14 Bell EF. ; American Academy of Pediatrics Committee on Fetus and Newborn. Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics 2007; 119 (02) 401-403
• 15 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. ACOG obstetric care consensus no. 3: periviable birth. Obstet Gynecol 2015; 126 (05) e82-e94