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

19 Scopus citations

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

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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