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Acta Obstet Gynecol Scand. 2018 Apr;97(4):491-499. doi: 10.1111/aogs.13264. Epub 2017 Dec 15.

Clinical decision analysis in perinatology.

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Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada.


Clinical decision-making in perinatology involves trade-offs between two intricately related individuals - mother and fetus. Decision-making in perinatology is challenging due to competing interests of the mother and the fetus. Although decision analytic methods are increasingly used to develop processes for clinical and cost-effectiveness analyses in perinatology, there are no guidelines on the conduct and reporting of decision analysis studies that takes into account the complexities of the mother-fetus dyad. This article describes the basics of decision analysis and highlights areas that require special consideration in the perinatal context. It emphasizes the importance of obtaining patient preferences related to combined maternal-fetal health states, stresses the relevance of both maternal and offspring health outcomes over appropriate time horizons, and explains challenges around the use of quality-adjusted life years as an outcome measure in perinatology. It also provides insight into the complexities of dyad status in clinical and cost-effectiveness analyses in perinatology.


Decision analysis; model-based economic evaluation; obstetrics; perinatology; pregnancy


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