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. 2020 Feb 3;20(1):20.
doi: 10.1186/s12905-020-0889-9.

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

J L Kerns  1 , J K Turk  2 , C M Corbetta-Rastelli  3 , M G Rosenstein  2   3 , A B Caughey  4 , J E Steinauer  2
Affiliations

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

J L Kerns et al. BMC Womens Health. .

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.

Keywords: Abortion; Dilation and evacuation; Family planning; Induction termination; Maternal fetal medicine; Provider attitudes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Proportions of FP and MFM physicians who believe patients prefer D&E, induction, or have no preference for different indications
Fig. 2
Fig. 2
Proportions of FP and MFM physicians who believe D&E is safer, induction is safer, or no difference in safety for different indications
See this image and copyright information in PMC

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