BACKGROUND Patients deciding to undergo dilation and evacuation (D&E) or induction abortion for fetal anomalies or complications may be greatly influenced by the counseling they receive. We sought to compare maternal-fetal medicine (MFM) and family planning (FP) physicians' attitudes and practice patterns around second-trimester abortion for abnormal pregnancies. METHODS We surveyed members of the Society for Maternal-Fetal Medicine and Family Planning subspecialists in 2010-2011 regarding provider recommendations between D&E or induction termination for various case scenarios. We assessed provider beliefs about patient preferences and method safety regarding D&E or induction for various indications. We compared responses by specialty using descriptive statistics and conducted unadjusted and adjusted analyses of factors associated with recommending a D&E. RESULTS Seven hundred ninety-four (35%) physicians completed the survey (689 MFMs, 105 FPs). We found that FPs had 3.9 to 5.5 times higher odds of recommending D&E for all case scenarios (e.g. 80% of FPs and 41% of MFMs recommended D&E for trisomy 21). MFMs with exposure to family planning had greater odds of recommending D&E for all case scenarios (p < 0.01 for all). MFMs were less likely than FPs to believe that patients prefer D&E and less likely to feel that D&E was a safer method for different indications. CONCLUSION Recommendations for D&E or induction vary significantly depending on the type of physician providing the counseling. The decision to undergo D&E or induction is one of clinical equipoise, and physicians should provide unbiased counseling. Further work is needed to understand optimal approaches to shared decision making for this clinical decision.

中文翻译：

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母胎医学和计划生育专科专家的孕中期流产态度和做法。

背景技术由于胎儿异常或并发症而决定进行扩张和撤离（D＆E）或诱导流产的患者可能会受到他们所接受咨询的影响。我们试图比较母胎医学（MFM）和计划生育（FP）医师在妊娠中期妊娠流产方面的态度和实践模式。方法我们调查了2010-2011年母婴医学与计划生育学会专科医生的情况，以了解在各种情况下D＆E或引产终止之间的提供者建议。我们评估了医疗服务提供者对患者偏好的信念以及有关D＆E或各种适应症诱导方法安全性的信念。我们使用描述性统计数据按专业比较了响应，并对与推荐D＆E相关的因素进行了未经调整和经过调整的分析。结果794名（35％）医生完成了调查（689 MFM，105 FP）。我们发现，在所有情况下，FP推荐D＆E的几率均高3.9至5.5倍（例如80％的FP和41％的MFM推荐21三体的D＆E）。接受计划生育的MFM在所有情况下建议D＆E的可能性更大（所有情况下p <0.01）。与FP相比，MFM不太可能相信患者更喜欢D＆E，并且不太可能认为D＆E是针对不同适应症的更安全方法。结论根据提供咨询的医师类型，对D＆E或入职的建议差异很大。进行D＆E或诱导的决定是临床平衡之一，医生应提供公正的咨询。需要进一步的工作来了解针对该临床决策的共享决策的最佳方法。