title: The effect of obstetric practice change to reduce early term delivery on perinatal outcome.
abstract: OBJECTIVE
  To investigate whether the national emphasis on attaining 39 weeks gestation has altered obstetric practice, and if so whether this has affected perinatal morbidity.
  
  
  METHODS
  We examined trends in gestational age, neonatal morbidity, maternal complications and stillbirth for a retrospective cohort of singleton, live births between 37+0 and 39+6 weeks of gestation over a 5-year period at a single tertiary care center.
  
  
  RESULTS
  There were 21 343 eligible deliveries. The proportion of deliveries in the early term (<39 weeks) decreased from 47.8 to 40.2% (P<0.01). The reduction was most pronounced for elective inductions (27.5 to 8.0%; P<0.01) and scheduled cesareans (56.9 to 24.9%; P<0.01), although a similar trend was seen for nonelective inductions (51.2 to 47.9%; P=0.03). In multivariable analysis, there was a 10% decreased odds of early term delivery per year (P<0.01). There were no changes in the rates of neonatal intensive care unit (NICU) evaluation (29.8 to 28.1%; P=0.11), pre-eclampsia (7.6 to 8.5%; P=0.06) or stillbirth (11.5 to 14.4 per 10 000; P=0.55).
  
  
  CONCLUSIONS
  A 10% annual decline in the odds of early term delivery was not accompanied by significant changes in perinatal morbidity.
authors.affiliation: Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Little
authors.affiliation: Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Robinson
authors.affiliation: Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Puopolo
authors.affiliation: Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Wilkins-Haug
authors.affiliation: Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Acker
authors.affiliation: Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Zera
mesh_terms: D002585:Cesarean Section / Q000639:trends; D036861:Delivery, Obstetric / Q000639:trends*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth; D047929:Term Birth