Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Apr;113(4):804-811.
doi: 10.1097/AOG.0b013e31819b5c8c.

Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system

Bryan T Oshiro  1 , Erick Henry, Janie Wilson, D Ware Branch, Michael W Varner; Women and Newborn Clinical Integration Program
Affiliations

Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system

Bryan T Oshiro et al. Obstet Gynecol. 2009 Apr.

Abstract

Objective: The American College of Obstetricians and Gynecologists has recommended that elective deliveries not be performed before 39 weeks of gestation, to minimize prematurity-related neonatal complications. Because a worrisome number of elective deliveries were occurring before 39 weeks of gestation in our system, we developed and implemented a program to decrease the number of these early term elective deliveries. Secondary objectives were to monitor relevant clinical outcomes.

Methods: The electronic medical records of an integrated health care system involving nine labor and delivery units in Utah were queried to establish the incidence of patients admitted for elective induction of labor or planned elective cesarean delivery. These facilities have open staff models with obstetricians, family practitioners, and certified nurse midwives. Guidelines were developed and implemented to discourage early term elective deliveries. The prevalence of early term elective deliveries was tracked and reported back regularly to the obstetric leadership and obstetric departments at each facility.

Results: The baseline prevalence of early term elective deliveries was 28% of all elective deliveries before the initiation of the program. Within 6 months of initiating the program, the incidence of near-term elective deliveries decreased to less than 10% and after 6 years continues to be less than 3%. A reduced length of stay in labor and delivery occurred with the introduction of the program, and there were no adverse effects on secondary clinical outcomes.

Conclusion: With institutional commitment, it is possible to substantially reduce and sustain a decline in the incidence of elective deliveries before 39 weeks of gestation.

Level of evidence: III.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Rayburn WF, Zhang J. Rising rates of labor induction: present concerns and future strategies. Obstet Gynecol 2002;100:164–7.
    1. Glantz JC. Labor induction rate variation in upstate New York: what is the difference? Birth 2003;30:168–74.
    1. Davidoff MJ, Dias T, Damus K, Russell R, Bettegowda VR, Dolan S, et al. Changes in the gestational age distribution among US singleton births: impact on rates of late preterm birth, 1992 to 2002 [published erratum appears in Semin Perinatol 2006;30:313]. Semin Perinatol 2006;39:8–15.
    1. Hankins GD, Clark SM, Munn MB. Cesarean section on request at 39 weeks: impact on shoulder dystocia, fetal trauma, neonatal encephalopathy, and intrauterine fetal demise. Semin Perinatol 2006;30:276–87.
    1. Madar J, Richmond S, Hey E. Surfactant-deficient respiratory distress after elective delivery at ‘term.' Acta Paediatr 1999;88:1244–8.

MeSH terms