Abstract
BackgroundPatients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive. We sought to compare maternal-fetal medicine (MFM) and family planning (FP) physicians’ attitudes and practice patterns around second-trimester abortion for abnormal pregnancies.MethodsWe surveyed members of the Society for Maternal-Fetal Medicine and Family Planning subspecialists in 2010–2011 regarding provider recommendations between D&E or induction termination for various case scenarios. We assessed provider beliefs about patient preferences and method safety regarding D&E or induction for various indications. We compared responses by specialty using descriptive statistics and conducted unadjusted and adjusted analyses of factors associated with recommending a D&E.ResultsSeven hundred ninety-four (35%) physicians completed the survey (689 MFMs, 105 FPs). We found that FPs had 3.9 to 5.5 times higher odds of recommending D&E for all case scenarios (e.g. 80% of FPs and 41% of MFMs recommended D&E for trisomy 21). MFMs with exposure to family planning had greater odds of recommending D&E for all case scenarios (p < 0.01 for all). MFMs were less likely than FPs to believe that patients prefer D&E and less likely to feel that D&E was a safer method for different indications.ConclusionRecommendations for D&E or induction vary significantly depending on the type of physician providing the counseling. The decision to undergo D&E or induction is one of clinical equipoise, and physicians should provide unbiased counseling. Further work is needed to understand optimal approaches to shared decision making for this clinical decision.
Highlights
Patients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive
Among all respondents (MFMs and family planning (FP) combined), D&E was recommended with the following frequency: 47% for trisomy 21, 42% for renal agenesis, 35% for intrauterine fetal demise (IUFD), 49% for severe pre-eclampsia, 46% for chorioamnionitis with sepsis, and 26% for premature rupture of membranes (PPROM)
D&E was the most common method done at their institution with the following frequency: 49% for trisomy 21; 37% for renal agenesis; 24% for IUFD; 26% for severe pre-eclampsia; 29% for chorioamnionitis with sepsis; 14% for PPROM
Summary
Patients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive. Women deciding to terminate a pregnancy in the second trimester for fetal anomalies or pregnancy complications can undergo one of two procedures – either a dilation and evacuation (D&E), or an induction termination. D&E and induction termination are both safe and effective [2], the decision to undergo D&E or induction is not always driven by choice. Access to both methods varies across the United States (US) with state, local, and institutional restrictions, insurance concerns, and provider availability posing barriers, most of which disproportionately affect D&E access. Kerns et al BMC Women's Health (2020) 20:20
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