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The effect of obstetric practice change to reduce early term delivery on perinatal outcome

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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.

Study Design:

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.

Result:

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).

Conclusion:

A 10% annual decline in the odds of early term delivery was not accompanied by significant changes in perinatal morbidity.

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Acknowledgements

This research was presented orally (abstract no. 27) at the 33rd Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, 11 to 16 February 2013.

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Correspondence to S E Little.

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Little, S., Robinson, J., Puopolo, K. et al. The effect of obstetric practice change to reduce early term delivery on perinatal outcome. J Perinatol 34, 176–180 (2014). https://doi.org/10.1038/jp.2013.166

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