Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries: Association With Obstetric Procedure Use and Health Outcomes.
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.



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.



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).



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.
Departments of Obstetrics and Gynecology and Public Health & Preventive Medicine, Oregon Health & Science University, Providence Health & Services, Legacy Health, Kaiser Permanente, Northwest Region, and the March of Dimes, Portland, Oregon; and the Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.
Jonathan M
JM
Snowden
Ifeoma
I
Muoto
Blair G
BG
Darney
Brian
B
Quigley
Mark W
MW
Tomlinson
Duncan
D
Neilson
Steven A
SA
Friedman
Joanne
J
Rogovoy
Aaron B
AB
Caughey
D000328:Adult; D001034:Apgar Score; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D002821:Chorioamnionitis / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D009922:Oregon / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D054238:Perinatal Mortality; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology