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Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries: Association With Obstetric Procedure Use and Health Outcomes.
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- Author(s): Snowden, Jonathan M.1,2 ; Muoto, Ifeoma1,2; Darney, Blair G.1,2; Quigley, Brian1,2; Tomlinson, Mark W.1,2; Neilson, Duncan1,2; Friedman, Steven A.1,2; Rogovoy, Joanne1,2; Caughey, Aaron B.1,2
- Source:
Obstetrics & Gynecology. Dec2016, Vol. 128 Issue 6, p1389-1396. 8p.- Subject Terms:
*ELECTIVE surgery; *DECISION making in elective surgery; *INDUCED labor (Obstetrics); *OBSTETRICS surgery; *HEALTH outcome assessment; *PREGNANCY complications; *LAW; *APGAR score; *BLOOD transfusion; *CESAREAN section; *FETAL diseases; *GESTATIONAL age; *HOSPITAL admission & discharge; *INFANT mortality; *NEONATAL intensive care; *PATIENTS; *PERINATAL death; *RESEARCH funding; *NEONATAL intensive care units; *RETROSPECTIVE studies; *FETAL macrosomia - Source:
- Additional Information
- Subject Terms:
- Abstract:
Objective: To evaluate the association of Oregon's hard-stop policy limiting early elective deliveries (before 39 weeks of gestation) and the rate of elective early-term inductions and cesarean deliveries and associated maternal-neonatal outcomes.Methods: This was a population-based retrospective cohort study of Oregon births between 2008 and 2013 using vital statistics data and multivariable logistic regression models. Our exposure was the Oregon hard-stop policy, defined as the time periods prepolicy (2008-2010) and postpolicy (2012-2013). We included all term or postterm, cephalic, nonanomalous, singleton deliveries (N=181,034 births). Our primary outcomes were induction of labor and cesarean delivery at 37 or 38 weeks of gestation without a documented indication on the birth certificate (ie, elective early term delivery). Secondary outcomes included neonatal intensive care unit admission, stillbirth, macrosomia, chorioamnionitis, and neonatal death.Results: The rate of elective inductions before 39 weeks of gestation declined from 4.0% in the prepolicy period to 2.5% during the postpolicy period (P<.001); a similar decline was observed for elective early-term cesarean deliveries (from 3.4% to 2.1%; P<.001). There was no change in neonatal intensive care unit admission, stillbirth, or assisted ventilation prepolicy and postpolicy, but chorioamnionitis did increase (from 1.2% to 2.2%, P<.001; adjusted odds ratio 1.94, 95% confidence interval 1.80-2.09).Conclusions: Oregon's statewide policy to limit elective early-term delivery was associated with a reduction in elective early-term deliveries, but no improvement in maternal or neonatal outcomes. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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