Patient’s Preferences for Management Options in Relation to Preterm Birth

To explore pregnant women’s preferences regarding cervical length measurement by ultrasound and treatment with progesterone in relation to preterm birth prevention we performed a discrete choice experiment. Four hospitals, four ultrasound centers and ten midwifery practices spread over the country participated in this study and distributed questionnaires among pregnant women between 15-36 weeks of gestation. Each questionnaire contained 16 choice sets with two screening or treatment options and one opt-out ‘no screening or treatment’ option. Women were asked to consider the following screening/treatment options 1) transvaginal or abdominal cervical length measurement, 2) vaginal or oral administration of progesterone, 3) short-term health risk and 4) long-term health risk for the child. The relative importance of the choices and trade-offs patients were willing to make were analyzed with panel-based mixed logit regression in STATA. Of the 156 questionnaires that were actually handed out, 138 were returned. Overall most respondents made trade-offs between attributes and all screening/treatment characteristics proved important in their decision making. Transvaginal cervical length measurements were not preferred (p=0.01) and was traded only in exchange for an absolute decrease of 6.5% (95% CI 2.6 – 10.4) in long-term neonatal complication rate. Previous experience with adverse neonatal outcome affected the preferences of the women.