Twelve percent of births in the United States occur before 37 weeks of gestation. Twenty percent of preterm deliveries are iatrogenic. A strict protocol was implemented for timing of elective term deliveries, mandating elective delivery below 39 weeks of gestation be approved by a maternal-fetal specialist. Because of awareness created by policy implementation, we hypothesized a decline in iatrogenic late preterm births. Iatrogenic late preterm birth was defined as elective delivery of neonates between 34 and 36.6 weeks of gestation excluding delivery for premature preterm rupture of membranes.
A retrospective study was conducted to review total number of spontaneous and induced late preterm births before and after policy implementation. A protocol for elective term deliveries was introduced in 2010. Data were studied between 2010 (before) and 2011–2013 (after) for total and iatrogenic late preterm births. Student's t test was used to compare data before and after protocol implementation. Stillbirths during the study period were also reviewed.
Mean number of total late preterm births per month before protocol was 41.25±11.14 and after protocol implementation was 37.10±12.66 (P=.373). Iatrogenic late preterm births before protocol implementation were 17.75±1.7 and after protocol implementation 8.03±3.83 (P=.008). The mean stillbirth rate before implementation of protocol was 2.07 and after 1.68 (P=.061). Number of elective deliveries before 39 weeks of gestation decreased from 23% to 2.8% (P=.02).
A statistically significant decline was noted in iatrogenic late preterm births after implementation of the 39-week protocol with no increase in stillbirth rate.