German obstetrician’s self-reported attitudes and handling in threatening preterm birth at the limits of viability

Katja Schneider; Johanna Müller; Ekkehard Schleußner

doi:10.1515/jpm-2022-0547

Article

German obstetrician’s self-reported attitudes and handling in threatening preterm birth at the limits of viability

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Published/Copyright: May 30, 2023

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From the journal Journal of Perinatal Medicine Volume 51 Issue 8

Abstract

Objectives

Antenatal treatment and information influences the course of pregnancy and parental decision-making in cases of threatened prematurity on the borderline of viability. Numerous studies have shown significant interprofessional differences in assessing ethical boundary decisions; hence, this study aimed to evaluate obstetricians attitudes, practices and antenatal parental counseling regarding threatened preterm birth in Germany.

Methods

An anonymous online questionnaire was administered to 543 obstetricians at tertiary perinatal centers and prenatal diagnostic centers in Germany. The survey contained questions on basic ethical issues assessed using the Likert scale and a case vignette regarding the practical procedures of an imminent extreme premature birth at 23 1/7 gestational weeks.

Results

In the case of unstoppable preterm birth, 15 % of clinicians said they would carry out a cesarean section; however, specialists from centers with a high number of very low birth weight infants would do so significantly more often. Among respondents, 29.8 % did not take any therapeutic measures without discussing the child’s treatment options with their parents, 19.9 % refused to offer actionable advice to the parents, and 57 % said they would advise parents to seek intensive care treatment for the child with the option of changing treatment destination in the event of serious complications. Moreover, 84 % said they would provide information together with neonatologists.

Conclusions

Joint counseling with neonatologists is widely accepted. The size of the perinatal center significantly influences the practical approach to threatened preterm births. Respect for parents’ decision-making autonomy regarding the child’s treatment options is central and influences therapy initiation.

Keywords: borderline of viability; decision-making; ethics; parental counseling; perinatology

Corresponding author: Dr. Katja Schneider, Department of Neonatology, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, Phone: +49 151 54694223, E-mail: Katja.schneider1@charite.de

Funding source: Deutsche Forschungsgemeinschaft

Award Identifier / Grant number: DFG, Project No. 456320782

Research funding: Dr. Katja Schneider’s work is supported in part by a grant from the German Research Council [DFG, Project No. 456320782]. The funding organization played no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the report or in the decision to submit the report for publication.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The author(s) state(s) no conflict of interest.
Informed consent: Not applicable.
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the local Ethics Committee of the Friedrich-Schiller-University of Jena (2020-1886-Bef).

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Received: 2022-11-12

Accepted: 2023-05-04

Published Online: 2023-05-30

Published in Print: 2023-10-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2022-0547

Keywords for this article

borderline of viability; decision-making; ethics; parental counseling; perinatology