Second-trimester abortion attitudes and practices among maternal-fetal medicine and family planning subspecialists

J. L. Kerns, J. K. Turk, C. M. Corbetta-Rastelli, M. G. Rosenstein, A. B. Caughey, J. E. Steinauer

Research output: Contribution to journalArticle

Abstract

Background: 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. We sought to compare maternal-fetal medicine (MFM) and family planning (FP) physicians' attitudes and practice patterns around second-trimester abortion for abnormal pregnancies. Methods: We 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. Results: Seven 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. Conclusion: Recommendations 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.

Original languageEnglish (US)
Article number20
JournalBMC Women's Health
Volume20
Issue number1
DOIs
StatePublished - Feb 3 2020

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Keywords

  • Abortion
  • Dilation and evacuation
  • Family planning
  • Induction termination
  • Maternal fetal medicine
  • Provider attitudes

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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