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Comparative Study
. 2010 Nov;203(5):449.e1-6.
doi: 10.1016/j.ajog.2010.05.036. Epub 2010 Jul 8.

Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth

Steven L Clark  1 , Donna R Frye, Janet A Meyers, Michael A Belfort, Gary A Dildy, Shalece Kofford, Jane Englebright, Jonathan A Perlin
Affiliations
Comparative Study

Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth

Steven L Clark et al. Am J Obstet Gynecol. 2010 Nov.

Abstract

Objective: No studies exist that have examined the effectiveness of different approaches to a reduction in elective early term deliveries or the effect of such policies on newborn intensive care admissions and stillbirth rates.

Study design: We conducted a retrospective cohort study of prospectively collected data and examined outcomes in 27 hospitals before and after implementation of 1 of 3 strategies for the reduction of elective early term deliveries.

Results: Elective early term delivery was reduced from 9.6-4.3% of deliveries, and the rate of term neonatal intensive care admissions fell by 16%. We observed no increase in still births. The greatest improvement was seen when elective deliveries at <39 weeks were not allowed by hospital personnel.

Conclusion: Physician education and the adoption of policies backed only by peer review are less effective than "hard stop" hospital policies to prevent this practice. A 5% rate of elective early term delivery would be reasonable as a national quality benchmark.

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