Practice variation in late-preterm deliveries: a physician survey

Objective: Late preterm (LPT) neonates account for over 70% of all preterm births in the US. Approximately 60% of LPT births are the result of non-spontaneous deliveries.The optimal timing of delivery for many obstetric conditions at LPT gestations is unclear, likely resulting in obstetric practice variation. The purpose of this study is to identify variation in the obstetrical management of LPT pregnancies. Study design: We surveyed obstetrical providers in NC identified from NC Medical Board and NC Obstetrical and Gynecological Society membership lists. Participants answered demographic questions and 6 multiple-choice vignettes on management of LPT pregnancies. Result: We obtained 215/859 (29%) completed surveys; 167 (78%) from Obstetrics/Gynecology, 27 (13%) from Maternal-Fetal Medicine, and 21 (10%) from Family Medicine physicians. Overall, we found more agreement on respondents’ management of chorioamnionitis (97% would proceed with delivery), mild preeclampsia (84% would delay delivery/expectantly manage), and fetal growth restriction (80% would delay delivery/expectantly manage). We found less agreement on the management of severe preeclampsia (71% would proceed with delivery), premature preterm rupture of membranes (69% would proceed with delivery), and placenta previa (67% would delay delivery/expectantly manage). Management of LPT pregnancies complicated by PPROM, FGR, and placenta previa vary by specialty. Conclusion: Obstetrical providers report practice variation in the management of LPT pregnancies. Variation might be influenced by provider specialty. The absence of widespread agreement on best practice might be a source of modifiable LPT birth

Regional Variation in Late Preterm Births in North Carolina

Late preterm (LPT) neonates (34 0/7th to 36 6/7th weeks' gestation) account for 70% of all premature births in the United States. LPT neonates have a higher morbidity and mortality risk than term neonates. LPT birth rates vary across geographic regions. Unwarranted variation is variation in medical care that cannot be explained by sociodemographic or medical risk factors; it represents differences in health system performance, including provider practice variation. The purpose of this study is to identify regional variation in LPT births in North Carolina that cannot be explained by sociodemographic or medical/obstetric risk factors