PREFERENCES OF PREGNANT-WOMEN AND PHYSICIANS FOR 2 STRATEGIES FOR PREVENTION OF EARLY-ONSET GROUP-B STREPTOCOCCAL SEPSIS IN NEONATES

Objectives: To assess preferences of pregnant women, pediatricians, an d obstetricians for the policies of the American College of Obstetrics and Gynecology (ACOG) and American Academy of Pediatrics (AAP) for re ducing the incidence of neonatal group B streptococcal (GBS) sepsis. D esign: An interactive interview using a computer-based decision-making model (analytic hierarchy process) and a self-administered survey ass essing the interview process. Setting: An obstetric clinic at a univer sity center and offices of practicing physicians from the Birmingham, Ala, area. Participants: Ninety-two pregnant women selected by a syste matic sampling technique and 40 pediatricians and 40 obstetricians sel ected randomly. Main Outcome Measure: Ranking of the ACOG and AAP poli cies and the 5 criteria on which the decision was based: risk of infec tion to an infant, knowledge of maternal GBS status, risk of anaphylax is to mother, diagnostic tests received by healthy infants, and cost. Satisfaction with the interview process also was measured. Results: Ei ghty-three women (90%), 40 pediatricians, and 40 obstetricians (100%) provided responses suitable for analysis. Sixty-seven pregnant women ( 81%), 26 pediatricians (65%), and 6 obstetricians (15%) preferred the AAP strategy. The ACOG policy was the preferred strategy by 34 (85%) o bstetricians. The 3 groups ranked risk of infection in an infant as th e most important criterion in their decisions. Ranks for the other cri teria differed among the 3 groups. Women ranked knowledge of maternal GBS status more important than did pediatricians and obstetricians. Th irty obstetricians (75%), 35 pediatricians (87.5%), and 72 pregnant wo men (86.7%) liked the interview. Seventy-three women (88%), 29 pediatr icians (72.5%),and 17 obstetricians (42.5%) thought physicians should use this type of interview to assist in managing patients. Conclusions : Pregnant women, pediatricians, and obstetricians had different prior ities when making a decision about GBS policies. These differences led obstetricians to prefer a different policy than that of pediatricians and pregnant women. Obstetricians were less likely to endorse the use of this decision-making technique in their practice than were patient s and pediatricians.