The Journal of family practice
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Spontaneous rupture of membranes during the second trimester presents difficult medical and ethical questions for the patient and physician. Such pregnancies are at high risk for preterm birth, chorioamnionitis, and neonatal complications. Treatment can range from expectant management to pregnancy termination. This case presentation describes a patient with premature rupture of membranes at 21 weeks' gestation who gave birth at 35 weeks.
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There is widespread variation in the prescribing patterns of postmenopausal hormone replacement therapy. While some degree of variation is expected, the systematic variation according to geographic region, physician gender, and medical specialty raises questions about how clinical decisions are made. ⋯ The primary care setting is proposed as the ideal context in which to study collaborative decision-making. Additional research is needed to more fully elucidate the value of collaborative decision-making with respect to clinical and quality-of-life outcomes, patient satisfaction with decision-making, and costs.