Obstetrics & Gynecology

Skip Navigation LinksHome > May 2013 - Volume 121 - Issue 5 > A Multistate Quality Improvement Program to Decrease Electiv...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31828ca096
Original Research

A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks of Gestation

Oshiro, Bryan T. MD; Kowalewski, Leslie BS; Sappenfield, William MD, MPH; Alter, Caroline C. MS; Bettegowda, Vani R. MHS; Russell, Rebecca MSPH; Curran, John MD; Reeves, Lori MPH; Kacica, Marilyn MD, MPH; Andino, Nelson MPA; Mason-Marti, Peyton MPH; Crouse, Dennis MD, PhD; Knight, Susan MA; Littlejohn, Karen MMHS; Malatok, Sharyn MPA; Dudley, Donald J. MD; Berns, Scott D. MD, MPH

Supplemental Author Material
Annual Awards
Collapse Box


OBJECTIVE: Nonmedically indicated (elective) deliveries before 39 weeks of gestation result in unnecessary neonatal morbidity. We sought to determine whether implementation of a process improvement program will decrease the rate of elective scheduled singleton early-term deliveries (37 0/7–38 6/7 weeks of gestation) in a group of diverse community and academic hospitals.

METHODS: Policies and procedures for scheduling inductions and cesarean deliveries were implemented and patient and health care provider education was provided. Outcomes for scheduled singleton deliveries at 34 weeks of gestation or higher were submitted through a web-based data entry system. The rate of scheduled singleton elective early-term deliveries as well as the rates of early-term medically indicated and unscheduled deliveries, neonatal intensive care unit admissions, and singleton term fetal mortality rate were evaluated.

RESULTS: A total of 29,030 scheduled singletons at 34 weeks of gestation or higher were delivered in 26 participating hospitals between January 2011 and December 2011. Elective scheduled early-term deliveries decreased from 27.8% in the first month to 4.8% in the 12th month (P<.001); rates of elective scheduled singleton early-term inductions (72%, P=.029) and cesarean deliveries (84%; P<.001) decreased significantly. There was no change in medically indicated or unscheduled early-term deliveries. Neonatal intensive care unit admissions among scheduled early-term singletons decreased nonsignificantly from 1.5% to 1.2% (P=.24). There was no increase in the term fetal mortality rate.

CONCLUSION: A rapid-cycle process improvement program substantially decreased elective scheduled early-term deliveries to less than 5% in a group of diverse hospitals across multiple states.


© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.



Looking for ABOG articles? Visit our ABOG MOC II collection. The selected Green Journal articles are free through the end of the calendar year.


If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.

Article Tools


Article Level Metrics