title: Induction rates and delivery outcomes after a policy limiting elective inductions.
abstract: The purpose of this study was to assess induction rates, maternal, and neonatal outcomes following adoption of a policy prohibiting elective inductions at less than 39 weeks gestation and inductions between 39 and 41 weeks with an unfavorable cervix. A retrospective cohort study of all deliveries greater than or equal to 37 weeks gestation was conducted 1 year prior to through 1 year after implementation of the induction policy. Induction rates before and after the policy were calculated as the primary outcome while maternal and neonatal conditions were assessed as secondary outcomes. Elective inductions (p = 0.016), elective inductions less than 39 weeks gestation (p = 0.020), and elective inductions 39-40 weeks and 6 days gestation with an unfavorable cervix (p = 0.031) decreased significantly following adoption of the policy. Maternal and neonatal outcomes, including rates of cesarean deliveries, postpartum hemorrhage, chorioamnionitis, and neonatal intensive care unit admissions remained unchanged, though this study was not adequately powered to detect differences in these outcomes. An institutional induction policy was associated with a reduction in elective inductions prior to 39 weeks and up to 40 weeks and 6 days with an unfavorable cervix. These reductions were not accompanied by change in maternal or neonatal outcomes at our institution.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A Burns School of Medicine, 1319 Punahou Street, #824, Honolulu, HI, 96826, USA, kyamasat@hawaii.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Yamasato
authors.forename: Marguerite
authors.initials: M
authors.lastname: Bartholomew
authors.forename: Marsha
authors.initials: M
authors.lastname: Durbin
authors.forename: Chieko
authors.initials: C
authors.lastname: Kimata
authors.forename: Bliss
authors.initials: B
authors.lastname: Kaneshiro
mesh_terms: D000328:Adult; D000650:Amnion / Q000601:surgery; D002585:Cesarean Section; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D005865:Gestational Age; D006254:Hawaii / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D007363:Intensive Care Units, Neonatal; D007751:Labor, Induced / Q000706:statistics & numerical data*; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult