Determining the rate of elective deliveries before 39 weeks of gestation: methodology matters.
Abundant evidence suggests that neonates delivered during the early-term period (before 39 weeks of gestation) have a small but significantly increased risk of morbidity. In an effort to reduce preventable adverse outcomes, there has been growing momentum aimed at eliminating elective deliveries before 39 weeks of gestation. One of the strategies to accomplish the goal is public reporting of institutional rates. Several organizations and institutions have developed measures to report early elective delivery rates. Methodology used to derive currently reported rates varies considerably. There are differences in how an elective compared with an indicated delivery is defined. There are also differences in the denominator used to calculate the rate, ranging from all of an institution's deliveries to a subset of deliveries occurring between 37 0/7 and 38 6/7 weeks of gestation. The former denominator will give a much smaller rate than the latter despite both having the same number of elective early-term deliveries. These variations make comparison of reported rates all but impossible. In this commentary, we describe several of the currently used methodologies and their effect on reported rates to make a case for standardization. It is our opinion that the Joint Commission methodology using a large list of International Classification of Diseases, 9th Revision codes to define indications for acceptable early-term deliveries and a defined subset of 37- and 38-week deliveries for the denominator combined with a requirement for validation of the reported data is the best method available at this time.
Mark W
MW
Tomlinson
Laurel
L
Durham
D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000592:standards* / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy