Do maternal characteristics influence maternal–fetal medicine physicians’ willingness to intervene when managing periviable deliveries?

Objective:determine the relative influence of patient characteristics on maternal–fetal medicine (mfm) physicians’ willingness to intervene when managing 23-week preterm premature rupture of membranes.study design:surveyed 750 randomly sampled us members of the society of maternal–fetal medicine. physicians rated their willingness to offer induction, order steroids and perform cesarean across eight vignettes; then completed a questionnaire querying expectations about neonatal outcomes and demographics.results:three hundred and twenty-five (43%) mfms responded. patient characteristics only influenced ⩽11% of participants’ willingness ratings. overall, provider characteristics and institutional norms were associated with willingness to perform antenatal interventions, for example, practice region was associated with willingness to offer induction (p<0.001), order steroids (p=0.008) and perform cesarean for distress (p=0.011); while institutional cesarean cutoffs were associated with willingness to order steroids and perform cesarean for labor and distress (all p<0.001).conclusion:physician-level factors and institutional norms, more so than patient characteristics, may drive periviable care and outcomes.