Attitudes Of Obstetricians Research Articles

Attitudes of obstetricians and gynecologists toward hormone replacement therapy.

To determine the attitudes of obstetricians and gynecologists toward hormone replacement therapy (HRT), and the beliefs and intuitions that affected those attitudes. A questionnaire was sent to 1,000 gynecologists in the United States; 328 replies were received. The questionnaire asked about effects of HRT, practices concerning HRT, and decisions in hypothetical scenarios. The respondents strongly favored HRT, and they were well informed about its effects on osteoporosis, cardiovascular disease, and breast cancer. They were aware of conflicting findings concerning breast cancer. The strength of their recommendation of HRT was sensitive to patient differences in risk factors. The respondents also showed four biases hypothesized to cause resistance to HRT: omission bias (more concern about harmful acts than harmful omissions); proportionality bias (attention to relative risk rather than risk differences); naturalness bias (preference for the natural); and ambiguity (avoiding options with missing information). Proportion bias, naturalness bias, and (weakly) omission bias were related to less favorable attitudes toward HRT. Although specialists are highly favorable toward HRT in general, some negativity toward HRT may result from decision biases.

Obstetricians' Views on Prenatal Diagnosis and Termination of Pregnancy

Objective To examine the attitudes of obstetricians in England and Wales concerning prenatal diagnosis and termination of pregnancy and to compare these with a similar survey carried out in 1980. Methods Postal questionnaires, based on those used in 1980, were sent to a random sample of 555 nonacademic consultant obstetricians, 71% of whom replied. Results The proportion of consultant obstetricians with a conscientious objection to termination of pregnancy was the same in both surveys, although virtually all conscientious objectors said that they made an exception for serious fetal abnormality. A major change was in the proportion saying that they generally required an undertaking to terminate an affected pregnancy before proceeding with amniocentesis: 75% in 1980 compared with 34% in 1993. As in 1980, lower priority is given to telling women of negative test results than of positive. More obstetricians in 1993 are prepared to consider terminations later in pregnancy, both for fetal abnormality and for social reasons, than was the case in 1980, but many are not prepared to recommend termination as late in pregnancy as the law allows. In some cases this is due to misapprehensions about what is legal. There are particular problems concerning terminations for fetal anomalies that not all would consider serious. One in seven of the 1993 sample would not recommend termination for cystic fibrosis at any gestation. Only 13 % would recommend termination for Down's syndrome beyond 24 weeks. There is a need not only for clarification of the law, but also of obstetrician's willingness to implement it.

Obstetricians' views on prenatal diagnosis and termination of pregnancy: 1980 compared with 1993.

To examine the attitudes of obstetricians in England and Wales concerning prenatal diagnosis and termination of pregnancy and to compare these with a similar survey carried out in 1980. Postal questionnaires, based on those used in 1980, were sent to a random sample of 555 nonacademic consultant obstetricians, 71% of whom replied. The proportion of consultant obstetricians with a conscientious objection to termination of pregnancy was the same in both surveys, although virtually all conscientious objectors said that they made an exception for serious fetal abnormality. A major change was in the proportion saying that they generally required an undertaking to terminate an affected pregnancy before proceeding with amniocentesis: 75% in 1980 compared with 34% in 1993. As in 1980, lower priority is given to telling women of negative test results than of positive. More obstetricians in 1993 are prepared to consider terminations later in pregnancy, both for fetal abnormality and for social reasons, than was the case in 1980, but many are not prepared to recommend termination as late in pregnancy as the law allows. In some cases this is due to misapprehensions about what is legal. There are particular problems concerning terminations for fetal anomalies that not all would consider serious. One in seven of the 1993 sample would not recommend termination for cystic fibrosis at any gestation. Only 13% would recommend termination for Down's syndrome beyond 24 weeks. There is a need not only for clarification of the law, but also of obstetrician's willingness to implement it.

Care for the imminent miscarriage by midwives and GPs.

A postal questionnaire was sent to a random sample of 495 Dutch general practitioners (GPs) and 278 midwives to evaluate the use of the 'imminent miscarriage' standard used by the Dutch College of General Practitioners. The response rates were 63 and 87% respectively. The first questions asked related to the respondents' routine management of an imminent miscarriage. The second part of the questionnaire addressed the respondents' attitude to the 17 most important guidelines in the standard. Finally, the respondents were invited to describe problems arising in adhering to the standard. Midwives and GPs differed in their management of an imminent miscarriage. Midwives used more 'technology' such as ultrasound scans or a doptone to trace complications or see if the fetus was still viable, whereas the GPs more often carried out vaginal and speculum examinations. Midwives also paid more attention to care following a miscarriage. The guidelines that many respondents did not adhere to involved the period of 10 days for the follow-up appointment and counselling after 6 weeks. Guidelines restricting ultrasound scans and the decision only to refer the patients to an obstetrician after three consecutive miscarriages were also not accepted by all respondents. Respondents mentioned several practical problems or obstacles in adhering to the standard, including women's requests for ultrasound scans or referrals and also the attitude of obstetricians who sometimes simply assumed control. The results will serve as a starting point for updating the standard.

Change in obstetric practice in response to fear of litigation in the British Isles

The increased number of medical negligence claims against obstetricians and gynaecologists has led to concerns about a trend towards defensive medical practice in the UK. The attitudes of obstetricians in the British Isles to tests of fetal and maternal wellbeing, which may influence decisions about patient care, were investigated in 3194 Fellows and Members of the Royal College of Obstetricians and Gynaecologists. Perceived accuracy of tests ranged from 86·3% for fetal blood sampling to 25·9% for biochemical tests. Despite some tests being perceived as having poor accuracy, all were widely used even by those who deemed them inaccurate. The most frequent explanations given for this paradoxical finding were that such tests were an aid to clinical judgement and were necessary for medicolegal reasons. Our data indicate that tests deemed to be inaccurate are used in clinical practice because some obstetricians fear litigation. Our findings were not influenced by age, gender, grade of doctor, or site of practice.

Attitudes of Obstetricians and Mid Wives: A Neglected Area of Study?

Attitudes of Obstetricians and Mid Wives: A Neglected Area of Study?

1482 DECREASE OF PERIVENTRICULAR HEMORRHAGE WITHOUT PLANNED INTERVENTION

Intraventricular/periventricular hemorrhage (IV-PVH) continues to be a major problem for preterm infants. Since the advent of ultrasound scanning, detection of IV-PVH has been made with some precision. We have routinely used an ATL sector scanner to detect IV-PVH in infants with gestational age ≤34 weeks since 1979. All scans have been interpreted by a single individual (WCA), providing a high degree of consistency. During the 5 year period Sept 1979-Aug 1984, we studied 637 infants ≤34 weeks gestation who survived for more than 24 hours. A progressive decline in the overall incidence of IV-PVH occurred, despite an increase in the proportion of infants ≤26 weeks gestation. Only 2% (7% of all IV-PVH) had evidence of parenchymal hemorrhage in 1981-84. The reasons for this decline are uncertain, but seem to include an increase in maternal-fetal transfers and changing attitudes of obstetricians towards extreme prematurity. The decline of IV-PVH without resorting to pharmacologic agents emphasizes the importance of controlled trials in evaluating intervention.

Outcome of Complicated Pregnancies of Less Than 27 Weeks of Gestation

In Reply.— I would certainly agree with Kilbridge and Elliot that obtaining outcome information from perinatal teams utilizing specified management approaches is the optimum. Attitudes of obstetricians and pediatricians about extremely low-birth-weight infants can influence both mortality and morbidity. Thus, the necessity for consistent cooperation and communication in the care of the extremely premature maternal-fetal unit is increasingly important both clinically and medicolegally. The surprisingly good early outcome of many extremely low-birth-weight survivors, as reported by us and others, mandates such an approach.