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Neonatal Outcomes After Implementation of Guidelines Limiting Elective Delivery Before 39 Weeks of Gestation

Ehrenthal, Deborah B. MD; Hoffman, Matthew K. MD, MPH; Jiang, Xiaozhang MD, MS; Ostrum, Gordon MD

doi: 10.1097/AOG.0b013e3182319c58
Original Research

OBJECTIVE: To evaluate the association of a new institutional policy limiting elective delivery before 39 weeks of gestation with neonatal outcomes at a large community-based academic center.

METHODS: A retrospective cohort study was conducted to estimate the effect of the policy on neonatal outcomes using a before and after design. All term singleton deliveries 2 years before and 2 years after policy enforcement were included. Clinical data from the electronic hospital obstetric records were used to identify outcomes and relevant covariates. Multivariable logistic regression was used to account for independent effects of changes in characteristics and comorbidities of the women in the cohorts before and after implementation.

RESULTS: We identified 12,015 singleton live births before and 12,013 after policy implementation. The overall percentage of deliveries occurring before 39 weeks of gestation fell from 33.1% to 26.4% (P<.001); the greatest difference was for women undergoing repeat cesarean delivery or induction of labor. Admission to the neonatal intensive care unit (NICU) also decreased significantly; before the intervention, there were 1,116 admissions (9.29% of term live births), whereas after, there were 1,027 (8.55% of term live births) and this difference was significant (P=.044). However, an 11% increased odds of birth weight greater than 4,000 g (adjusted odds ratio 1.11; 95% confidence interval [CI] 1.01–1.22) and an increase in stillbirths at 37 and 38 weeks, from 2.5 to 9.1 per 10,000 term pregnancies (relative risk 3.67, 95% CI 1.02–13.15, P=.032), were detected.

CONCLUSION: A policy limiting elective delivery before 39 weeks of gestation was followed by changes in the timing of term deliveries. This was associated with a small reduction in NICU admissions; however, macrosomia and stillbirth increased.

LEVEL OF EVIDENCE: III

Limiting elective delivery before 39 weeks of gestation is associated with a reduction in neonatal intensive care unit admission but only a small increase in macrosomia and stillbirth.

From the Departments of Obstetrics and Gynecology and Internal Medicine, Christiana Care Health System, and Christiana Center for Outcomes Research, Newark, Delaware.

Presented in abstract form at the annual clinical meeting of the Society of Maternal Fetal Medicine, February 7–12, 2011, San Francisco, California.

Corresponding author: Deborah B. Ehrenthal, MD, Department of Obstetrics and Gynecology, Christiana Care Health Services, 4755 Ogletown-Stanton Road, Newark, DE 19718; e-mail: Dehrenthal@Christianacare.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.