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P036Exploring us obstetrician-gynecologists’ characterization of periviable pregnancy-ending interventions: A mixed methods study

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      Objectives

      To explore how US obstetrician gynecologists (Ob-Gyns) characterize periviable pregnancy-ending interventions as obstetric or abortion care, and to understand how those determinations are made.

      Methods

      From April to June 2021, we performed an explanatory sequential mixed methods study of US Ob-Gyns, recruited through overlapping online communities. We administered a cross-sectional survey requesting characterization of eight potentially ambiguous clinical scenarios, using chi-square tests to compare determinations by physician and institutional factors. We then conducted semi-structured interviews in a diverse nested sample, merging quantitative and qualitative data about decision making in a joint mixed methods analysis.

      Results

      We received 209 survey responses, with 101 (48.3%) current abortion providers and 42 (20.1%) never-providers, and completed 21 qualitative interviews. Characterization of pregnancy-ending interventions as induced abortion ranged from 21.1% for a 22-week labor induction in setting of chorioamnionitis, to 83.1% for a 24-week feticidal injection and labor induction in setting of fetal anencephaly. Interventions were less often characterized as abortion when performed for maternal indications, for instance only 42.6% of respondents felt a 22-week dilation and evacuation for chorioamnionitis was an abortion, compared to 82.1% for 24-week dilation and evacuation for anencephaly (p<0.001). Other significant associations with abortion determination included method type (procedural more likely than medication-only), abortion experience (ever-providers more likely than never-providers), and state and institutional abortion regulations (“I have to call it a medical inducement.…I'm not allowed to use the word abortion.”).

      Conclusions

      Unclear definitions and administrative overreach lead to inconsistency and subjectivity in care for periviable pregnancy complications. With widespread abortion restrictions, characterization of interventions can affect access to necessary medical care.
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