Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries

Association with Obstetric Procedure Use and Health Outcomes

Jonathan Snowden, Ifeoma Muoto, Blair Darney, Brian Quigley, Mark W. Tomlinson, Duncan Neilson, Steven A. Friedman, Joanne Rogovoy, Aaron Caughey

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE: 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. METHODS: 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 (N181,034 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. RESULTS: 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). CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)1389-1396
Number of pages8
JournalObstetrics and Gynecology
Volume128
Issue number6
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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Obstetrics
Chorioamnionitis
Stillbirth
Neonatal Intensive Care Units
Health
Pregnancy
Logistic Models
Mothers
Parturition
Induced Labor
Birth Certificates
Vital Statistics
Ventilation
Cohort Studies
Retrospective Studies
Odds Ratio
Head
Confidence Intervals
Population

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries : Association with Obstetric Procedure Use and Health Outcomes. / Snowden, Jonathan; Muoto, Ifeoma; Darney, Blair; Quigley, Brian; Tomlinson, Mark W.; Neilson, Duncan; Friedman, Steven A.; Rogovoy, Joanne; Caughey, Aaron.

In: Obstetrics and Gynecology, Vol. 128, No. 6, 01.12.2016, p. 1389-1396.

Research output: Contribution to journalArticle

Snowden, Jonathan ; Muoto, Ifeoma ; Darney, Blair ; Quigley, Brian ; Tomlinson, Mark W. ; Neilson, Duncan ; Friedman, Steven A. ; Rogovoy, Joanne ; Caughey, Aaron. / Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries : Association with Obstetric Procedure Use and Health Outcomes. In: Obstetrics and Gynecology. 2016 ; Vol. 128, No. 6. pp. 1389-1396.
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abstract = "OBJECTIVE: 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. METHODS: 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 (N181,034 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. RESULTS: 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). CONCLUSIONS: 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.",
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T1 - Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries

T2 - Association with Obstetric Procedure Use and Health Outcomes

AU - Snowden, Jonathan

AU - Muoto, Ifeoma

AU - Darney, Blair

AU - Quigley, Brian

AU - Tomlinson, Mark W.

AU - Neilson, Duncan

AU - Friedman, Steven A.

AU - Rogovoy, Joanne

AU - Caughey, Aaron

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N2 - OBJECTIVE: 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. METHODS: 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 (N181,034 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. RESULTS: 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). CONCLUSIONS: 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.

AB - OBJECTIVE: 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. METHODS: 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 (N181,034 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. RESULTS: 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). CONCLUSIONS: 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.

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