Do maternal characteristics influence maternal-fetal medicine physicians' willingness to intervene when managing periviable deliveries?

OBJECTIVE: Determine the relative influence of patient characteristics on Maternal-Fetal Medicine (MFM) physicians' willingness to intervene when managing 23-week preterm premature rupture of membranes. STUDY DESIGN: Surveyed 750 randomly sampled US members of the Society of Maternal-Fetal Medicine. Physicians rated their willingness to offer induction, order steroids and perform cesarean across eight vignettes; then completed a questionnaire querying expectations about neonatal outcomes and demographics. RESULTS: Three hundred and twenty-five (43%) MFMs responded. Patient characteristics only influenced. 11% of participants' willingness ratings. Overall, provider characteristics and institutional norms were associated with willingness to perform antenatal interventions, for example, practice region was associated with willingness to offer induction (P < 0.001), order steroids (P = 0.008) and perform cesarean for distress (P = 0.011); while institutional cesarean cutoffs were associated with willingness to order steroids and perform cesarean for labor and distress (all P < 0.001). CONCLUSION: Physician-level factors and institutional norms, more so than patient characteristics, may drive periviable care and outcomes.