• B Tucker Edmonds, F McKenzie, J E Panoch, A E Barnato, and R M Frankel.
• Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
• J Perinatol. 2015 May 1; 35 (5): 344-8.

ObjectiveTo compare the management options, risks and thematic content that obstetricians and neonatologists discuss in periviable counseling.Study DesignSixteen obstetricians and 15 neonatologists counseled simulated patients portraying a pregnant woman with ruptured membranes at 23 weeks of gestation. Transcripts from video-recorded encounters were qualitatively and quantitatively analyzed for informational content and decision-making themes.ResultObstetricians more frequently discussed antibiotics (P=0.005), maternal risks (<0.001) and cesarean risks (<0.005). Neonatologists more frequently discussed neonatal complications (P=0.044), resuscitation (P=0.015) and palliative options (P=0.023). Obstetricians and neonatologists often deferred questions about steroid administration to the other specialty. Both specialties organized decision making around medical information, survival, quality of life, time and support. Neonatologists also introduced themes of values, comfort or suffering, and uncertainty.ConclusionObstetricians and neonatologists provided complementary counseling content to patients, yet neither specialty took ownership of steroid discussions. Joint counseling and/or family meetings may minimize observed redundancy and inconsistencies in counseling.

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