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Ferrand A, Poleksic J, Racine E. Factors Influencing Physician Prognosis: A Scoping Review. MDM Policy Pract 2022; 7:23814683221145158. [PMID: 36582416 PMCID: PMC9793048 DOI: 10.1177/23814683221145158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction. Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. Methods. We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. Results. Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). Discussion. Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician's personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research. Highlights Literature on discrepancies in physician's prognostication is heterogeneous and sparse.Literature shows that physicians are mostly pessimistic regarding patient outcomes.Literature shows that a physician's personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies.Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic.Physicians early in their training were more pessimist than more experienced physicians.
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Affiliation(s)
- Amaryllis Ferrand
- Amaryllis Ferrand, Pragmatic Health Ethics
Research Unit, Montreal Clinical Research Institute, 10 Pine Ave West, Montreal,
QC H2W 1R7, Canada; ()
| | - Jelena Poleksic
- Pragmatic Health Ethics Research Unit, Montreal
Clinical Research Institute, Montreal, QC, Canada,Faculty of Medicine, University of Western
Ontario, London, ON, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Montreal
Clinical Research Institute, Montreal, QC, Canada,Departments of Medicine and Social and
Preventive Medicine, University of Montreal, Montreal, Canada,Biomedical Ethics Unit, McGill University,
Montreal, QC, Canada
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Ward C, Caughey AB. Late preterm births: neonatal mortality and morbidity in twins vs. singletons. J Matern Fetal Neonatal Med 2021; 35:7962-7967. [PMID: 34154507 DOI: 10.1080/14767058.2021.1939303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the outcomes of twins and singletons in the late preterm period. MATERIALS AND METHODS This is a retrospective cohort study of data obtained for 165,894 births in California who delivered between 34 + 0 and 36 + 6 weeks. The primary outcome was neonatal and infant mortality. The secondary outcomes included the following neonatal morbidities: respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), seizure, and sepsis. Univariate analysis was performed using chi-square test and multivariable logistic regression was used to adjust for potential confounders. RESULTS There were 143,891 singleton and 22,003 twin gestations included in the study. There was no difference in the primary outcome, neonatal and infant mortality between twins and singletons delivered at 34 and 36 weeks. After controlling for multiple potential confounders, significant differences in secondary outcomes of neonatal morbidity were identified. At 34 weeks, twins had significantly higher rates of IVH (aOR 2.47 (95%CI 1.08-5.64)), NEC (aOR 2.46 (95%CI 1.42-4.29)), RDS (aOR 1.60 (95%CI 1.45-1.77)), and sepsis (aOR 1.19 (95%CI 1.05-1.34)) compared to singletons. By 36 weeks, only an increased risk of RDS persisted among twins. CONCLUSIONS While there was no difference in mortality among twins and singletons in the late preterm period, twins may have significantly increased neonatal morbidity compared to singletons delivered between 34 + 0 and 36 + 6 weeks.
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Affiliation(s)
- Clara Ward
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Aaron B Caughey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Oregon Health and Science University, Portland, OR, USA
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Gao H, Wang YF, Huang K, Han Y, Zhu YD, Zhang QF, Xiang HY, Qi J, Feng LL, Zhu P, Hao JH, Tao XG, Tao FB. Prenatal phthalate exposure in relation to gestational age and preterm birth in a prospective cohort study. ENVIRONMENTAL RESEARCH 2019; 176:108530. [PMID: 31220737 DOI: 10.1016/j.envres.2019.108530] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/20/2019] [Accepted: 06/08/2019] [Indexed: 06/09/2023]
Abstract
This study enrolled 3266 pregnant women, to explore the relationship of prenatal phthalate exposure with the risk of preterm birth and gestational age. All participants filled questionnaires and provided with up to three urine samples during three trimesters. Seven phthalate metabolites in urines were measured. The incidences of very preterm, late preterm, early-term, late-term and postterm births were 0.58%, 3.52%, 24.22%, 10.53%, and 0.34%, respectively. Non-linear relationships were shown between phthalate metabolites and gestational age. Except for monomethyl phthalate (OR = 1.65, 95%CI = 1.17-2.34), the average concentrations of phthalate metabolites were associated with a slightly and insignificantly increased risk of overall preterm birth (<37+0 gestational weeks). Through a restricted cubic spline regression, phthalate metabolites were found to be related to the risk of overall preterm birth in a linear manner (p-value >0.05) or a non-linear manner (p-value <0.05). All curves indicated the overall preterm birth risk rose with the increase of phthalate metabolite concentrations. Finally, compared with full-term birth (39+0 to 40+6 gestational weeks), phthalate metabolites were associated with the elevated risks of very preterm, late preterm and postterm births, although some relationships were not statistically significant. In conclusion, these findings suggested non-linear associations between phthalate metabolites and gestational age. Exposure to some phthalate metabolites was associated with increased risks of overall preterm birth and postterm birth.
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Affiliation(s)
- Hui Gao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Ya-Fei Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Yan Han
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Yuan-Duo Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Qiu-Feng Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Hai-Yun Xiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Juan Qi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Lan-Lan Feng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Jia-Hu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Xu-Guang Tao
- Division of Occupational and Environmental Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China.
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Differences in the prognosis of preeclampsia according to the initial symptoms: A single-center retrospective report. Pregnancy Hypertens 2019; 16:126-130. [PMID: 31056147 DOI: 10.1016/j.preghy.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/14/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
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Nakamura E, Samejima K, Takayanagi N, Ono Y, Matsunaga S, Nagai T, Takai Y, Saitoh M, Baba K, Seki H. Retrospective study of umbilical cord ulceration related to congenital intestinal atresia: A single-center report. J Obstet Gynaecol Res 2018. [PMID: 29516584 DOI: 10.1111/jog.13611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Umbilical cord ulceration (UCU) is a disease in which an ulcer forms in the umbilical cord in the pregnant uterus and is accompanied by hemorrhaging from the same site. UCU occurs in fetuses with congenital upper-intestinal atresia (CUIA); however, its onset mechanism remains unclear. Here, we report our investigation of cases of UCU in our hospital. METHODS Among the 9825 deliveries performed between 2007 and 2016 at this hospital, 20 fetuses were diagnosed with CUIA, 4 (20%) of which had UCU. There was no difference in the backgrounds of the fetuses with UCU (UCU group: 4 fetuses) and those without (non-UCU group: 16 fetuses). RESULTS There was no intergroup difference in gestational age at delivery. Four cases in the UCU group had maternal age 35 weeks (26-39), weeks of delivery 35 weeks (35-36) and weight 2178.5 g (1600-2640); three out of four fetuses were female; and the location of gastrointestinal obstruction was in the duodenum in one case and in the jejunum in three cases. Death occurred in three of four fetuses in the UCU group versus none in the non-UCU group. CONCLUSION We performed a retrospective statistical investigation on the risk of UCU onset in cases from this hospital; however, we could not identify any prognostic factors for its onset. We investigated a total of 27 past reported UCU cases and the 4 cases in this study. Mean gestational age at onset was 33.3 ± 2.7 for all 27 cases. Various methods for the early discovery of UCU have been reported in the past; however, there is currently no gold standard. Based on this report and a review of past papers, for CUIA, it is desirable to perform in-hospital management from gestational week 30 onward and decide proper delivery timing on a case-by-case basis.
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Affiliation(s)
- Eishin Nakamura
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kouki Samejima
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Natsuko Takayanagi
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoshihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomonori Nagai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masahiro Saitoh
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazunori Baba
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroyuki Seki
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Prematuridad tardía: una población de riesgo. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Early developmental outcomes predicted by gestational age from 35 to 41weeks. Early Hum Dev 2016; 103:85-90. [PMID: 27536852 DOI: 10.1016/j.earlhumdev.2016.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/30/2016] [Accepted: 07/17/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recent studies have indicated that children born only a few weeks earlier than their due date experience more health and cognitive problems than previously realized. AIMS Our study investigated whether gestational age (GA) at birth (35-41weeks) predicted developmental outcomes at 8, 12, 20, or 24months of age. STUDY DESIGN Archival records of developmental screening scores collected between 2006 and 2012 were analyzed using negative binomial and logistic regressions models. SUBJECTS Eight-month (N=3319), 12-month (N=2303), 20-month (N=1461) and 24-month (N=1222) old children were assessed in a county-wide developmental screening program. OUTCOME MEASURES Ages and Stage Questionnaires (ASQs) scores. RESULTS After controlling for demographic covariates, from 35weeks of gestation on, each additional week of gestation (through 41) significantly reduced the overall risk for developmental delay at 8,12, 20 and 24-months of age. Gestational age also uniquely predicted specific risk for delay in the domains of communication, personal-social, fine-motor, and problem solving at various time-points during the first two years of life. CONCLUSIONS With each additional week of gestation past 35weeks there was a graded decrease in the overall risk of developmental delay as well as in specific domains such as communication across the first two years of life. This evidence for the "dose-response" effect of GA on later development suggests that close monitoring of developmental outcomes for children born before 40weeks is warranted.
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England LJ, Anderson BL, Tong VTK, Mahoney J, Coleman-Cowger VH, Melstrom P, Schulkin J. Screening practices and attitudes of obstetricians-gynecologists toward new and emerging tobacco products. Am J Obstet Gynecol 2014; 211:695.e1-7. [PMID: 24881828 PMCID: PMC4602388 DOI: 10.1016/j.ajog.2014.05.041] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/22/2014] [Accepted: 05/28/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We examined screening practices and attitudes of obstetricians-gynecologists toward the use of noncombustible tobacco products (chewing tobacco, snuff/snus, electronic cigarettes, and dissolvables) during pregnancy. STUDY DESIGN The authors mailed a survey in 2012 to 1024 members of the American College of Obstetricians and Gynecologists, including Collaborative Ambulatory Research Network (CARN) and non-CARN members. Stratified random selection was used to generate CARN and non-CARN samples. RESULTS Response rates were 52% and 31% for CARN and non-CARN members, respectively. Of 252 total eligible respondents (those currently providing obstetrics care) 53% reported screening pregnant women at intake for noncombustible tobacco product use all or some of the time, and 40% reported none of the time. Respondents who reported that noncombustible products have adverse health effects during pregnancy, but are safer than cigarettes, ranged from 20.2% (dissolvables) to 29% (electronic cigarettes) and that the health effects are the same as those of cigarettes from 13.5% (electronic cigarettes) to 53.6% (chewing tobacco). Approximately 14% reported that electronic cigarettes have no adverse health effects; <1% reported no health effects for the remaining products. Two-thirds of the respondents wanted to know more about the potential health effects of noncombustible tobacco products; only 5% believed themselves to be fully informed. CONCLUSION A large proportion of obstetrician-gynecologists reported never or inconsistently screening their pregnant patients for the use of noncombustible tobacco products. Responses regarding the harms of these products relative to cigarettes were mixed and most respondents wanted more information. Development and dissemination of guidance for providers is needed to improve decision-making regarding noncombustible tobacco products.
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Affiliation(s)
- Lucinda Jane England
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | | | - Van Thi Ky Tong
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jeanne Mahoney
- American College of Obstetricians and Gynecologists, Washington, DC
| | | | - Paul Melstrom
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jay Schulkin
- American College of Obstetricians and Gynecologists, Washington, DC
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Avraham S, Azem F, Seidman D. Preterm birth prevention: how well are we really doing? A review of the latest literature. J Obstet Gynaecol India 2014; 64:158-64. [PMID: 24966497 PMCID: PMC4061325 DOI: 10.1007/s13224-014-0571-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022] Open
Abstract
Preterm birth is a global concern resulting in prematurity which is the leading cause of newborn death and long-term squeal in the survivors. In this review, we will summarize the data available to this date in regard to the causes, available interventions, and contemporary research for future applications.
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Affiliation(s)
- Sarit Avraham
- />Department of Obstetrics and Gynecology, Liss Maternitry Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel
- />The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Fouad Azem
- />Department of Obstetrics and Gynecology, Liss Maternitry Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel
- />The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Daniel Seidman
- />Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
- />The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv Medical Center, Tel-Aviv, Israel
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Chabra S. The enigma of 36 completed weeks of gestation: 36 0/7 or 36 6/7? J Womens Health (Larchmt) 2014; 23:437. [PMID: 24724626 DOI: 10.1089/jwh.2014.4741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shilpi Chabra
- Department of Pediatrics, Division of Neonatology, University of Washington , Seattle, Washington
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Power ML, Schulkin J. The authors' response. J Womens Health (Larchmt) 2014; 23:438. [PMID: 24649972 DOI: 10.1089/jwh.2014.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael L Power
- Research Department, American College of Obstetricians and Gynecologists , Washington, DC
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Vink J, Anderson B, Fuchs K, Schulkin J, D'Alton ME. Opinions and practice patterns of obstetricians-gynecologists in the United States regarding amniocentesis in twins. Prenat Diagn 2013; 33:899-903. [PMID: 23703651 DOI: 10.1002/pd.4164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 05/09/2013] [Accepted: 05/18/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Accurate amniocentesis-related pregnancy loss (ARL) rates for twin gestations remains elusive because of varying ARL definitions in the literature. We examined how OB/GYNs define/counsel women carrying twins about ARL. METHODS A random sample of 1000 American College of OB/GYN (ACOG) fellows and ACOG Collaborative Ambulatory Research Network (CARN) members were mailed surveys about their opinions/practice patterns regarding amniocentesis in twins. There were 208/400 (52%) CARN members and 166/600 (27%) ACOG fellows who returned the survey (37% response rate). RESULTS Of respondents, 80.8% practiced general OB/GYN, and 9.1% practiced maternal fetal medicine. Of respondents, 72% discussed amniocentesis for prenatal diagnosis. Of these, 91.7% discuss the risk of ARL; however, 47.4% do not quote an ARL rate. Of those who discuss ARL rates, 65% quote a rate greater than for singletons. Regarding monochorionic-diamniotic twins, 12.1% of respondents said the ARL rate was less, 39.6% said equal to, and 38.9% said greater than for dichorionic twins. Table 1 lists the most common clinical definitions/time intervals used to describe ARL. CONCLUSION Various definitions/ARL rates are used when counseling about ARL in twins. Further studies using a widely accepted definition of ARL are necessary to improve the counseling of women considering amniocentesis for prenatal diagnosis in twins.
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Affiliation(s)
- Joy Vink
- Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University Medical Center, New York, NY, USA.
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