Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system.
OBJECTIVE
The American College of Obstetricians and Gynecologists has recommended that elective deliveries not be performed before 39 weeks of gestation, to minimize prematurity-related neonatal complications. Because a worrisome number of elective deliveries were occurring before 39 weeks of gestation in our system, we developed and implemented a program to decrease the number of these early term elective deliveries. Secondary objectives were to monitor relevant clinical outcomes.


METHODS
The electronic medical records of an integrated health care system involving nine labor and delivery units in Utah were queried to establish the incidence of patients admitted for elective induction of labor or planned elective cesarean delivery. These facilities have open staff models with obstetricians, family practitioners, and certified nurse midwives. Guidelines were developed and implemented to discourage early term elective deliveries. The prevalence of early term elective deliveries was tracked and reported back regularly to the obstetric leadership and obstetric departments at each facility.


RESULTS
The baseline prevalence of early term elective deliveries was 28% of all elective deliveries before the initiation of the program. Within 6 months of initiating the program, the incidence of near-term elective deliveries decreased to less than 10% and after 6 years continues to be less than 3%. A reduced length of stay in labor and delivery occurred with the introduction of the program, and there were no adverse effects on secondary clinical outcomes.


CONCLUSIONS
With institutional commitment, it is possible to substantially reduce and sustain a decline in the incidence of elective deliveries before 39 weeks of gestation.


METHODS
III.
Oshiro
Bryan T
BT
From the Women & Newborn Clinical Integration Program, Intermountain Healthcare, Salt Lake City, Utah; Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; and Department of Obstetrics and Gynecology, Loma Linda University, Loma Linda, California.
Henry
Erick
E
Wilson
Janie
J
Branch
D Ware
DW
Varner
Michael W
MW
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D007744:Obstetric Labor Complications / Q000453:epidemiology; D009774:Obstetrics / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D047929:Term Birth; D014589:Utah / Q000453:epidemiology