13. 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 exceptional cases of severe and life-theatening maternal conditions in the periviable period, professionals may consider immediate delivery the only option to prevent deterioration of the maternal illness. Fetal demise is then the inevitable consequence of the treatment of the mother. We sought the opinion of involved medical specialists on management, reporting and auditing in these difficult cases. Methods All registered fetal-maternal medicine specialists (MFM-specialists) (n = 197) and neonatologists (n = 282) were invited to participate in an online survey. The survey presented to hypothetical cases of severe early-onset preeclampsia at periviable gestational age. Two management-options were presented: immediate delivery and expectant management directed towards newborn survival. During expectant management two epsiodes with eclamptic seizures occured. Findings In the case managed by immediate termination, 62% answered that fetal demise resulting from induction of labor for severe maternal illness should be audited within the medical profession only. In the case managed expectantly, 17% agreed with this management. 75% of MFM-specialists answered that an eclamptic seizure is always a reason for immediate delivery. Some answers revealed a significant difference in opinion between the MFM-specialists and the neonatologists. The first concern of the MFM-specialists is the health of the mother, while the first concern of the neonatologists is, to achieve optimal gestational age for the newborn. Conclusion Perpective of MFM-specialists and neonatologists differs with regard to counseling prospect parents in case of severe early-onset preeclampsia. The majority of professionals is willing to report late termination of pregnancy (after 24 weeks’ gestation) for severe maternal disease to medical experts for internal audits, but not for legal auditing.