RESUMO
OBJECTIVE: This study aimed to analyze characteristics of those seen for threatened preterm labor (tPTL) who receive antenatal corticosteroids (ACS) to better understand clinical decision-making. STUDY DESIGN: This retrospective cohort study consisted of patients seen in triage at an urban county hospital in 2021 for tPTL during pregnancy. Demographic variables (maternal age, race/ethnicity, and prior preterm delivery) and obstetrical variables (cervical dilation, effacement, membrane rupture, and tocolytic administration) were evaluated against the primary outcome of ACS administration. RESULTS: After exclusions, a cohort of 290 pregnant people with 372 unique encounters for tPTL remained. The mean maternal age was 26.7, and 15.6% of patients had a history of prior preterm birth. A total of 107 patients in 111 encounters received ACS, which were associated with lower body mass index (BMI), greater cervical dilation, greater effacement, membrane rupture, and more frequent contractions (all ps < 0.01). The mean presentation was at 33.5 weeks. Only 44% of those receiving ACS delivered within 7 days, compared with 11% of those who did not receive ACS (p < 0.001). Half (50%) of the patients receiving ACS delivered at >37 weeks. Adjusting for significant factors in the univariable analysis and limited to first encounter in triage, BMI (odds ratio: 0.91, 95% confidence interval: 0.87-0.95), cervical dilation ≥ 2 cm (2.49, 1.12-5.35), and cervical effacement ≥ 50% (4.80, 2.25-10.24) were significantly associated with patients receiving ACS. CONCLUSION: Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, although most patients receiving ACS still did not deliver within 7 days. KEY POINTS: · In a cohort of 290 patients with 373 encounters for threatened preterm labor, 37% received ACS.. · We found that only 40% of those who received ACS delivered within 7 days and half went on to deliver at term.. · Cervical dilation ≥2 cm (odds ratio, 95% confidence interval: 2.49, 1.12-5.35) and effacement ≥50% (4.80, 2.25-10.24) were independently associated with receiving ACS..
RESUMO
OBJECTIVE: To qualitatively evaluate women's perspectives on shared decision-making for periviable (22-25 weeks' gestational age) mode of delivery (MOD). STUDY DESIGN: Interviews were conducted at two Midwestern academic hospitals with 30 women hospitalized for threatened periviable delivery between September 2016 and January 2018. Prior to delivery (T1) and at 3-months postpartum (T2), MOD-related decision-making was explored using prompts. Interviews were coded and analyzed using NVivo 12. RESULT: The majority of women perceived the MOD options as cesarean section or vaginal delivery. Most ultimately preferred "whatever's best for baby." Understanding of MOD risks was limited, and physicians recommended each option equally. Sixteen participants perceived themselves as decision-makers at T1, while at T2, only nine participants identified themselves as such. CONCLUSION: Informed deference is introduced as a novel concept in the setting of periviable MOD decision-making, whereby the mother defers decisional authority to the provider, the baby, a higher power, or the circumstance itself.