Oregonʼs Hard-Stop Policy Limiting Elective Early-Term Deliveries: Association With Obstetric Procedure Use and Health Outcomes

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 128; no. 6; pp. 1389 - 1396
• Main Authors: Snowden, Jonathan M, Muoto, Ifeoma, Darney, Blair G, Quigley, Brian, Tomlinson, Mark W, Neilson, Duncan, Friedman, Steven A, Rogovoy, Joanne, Caughey, Aaron B
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.12.2016
• Subjects: Adult; Apgar Score; Blood Transfusion - statistics & numerical data; Cesarean Section - legislation & jurisprudence; Cesarean Section - statistics & numerical data; Cesarean Section - trends; Chorioamnionitis - epidemiology; Elective Surgical Procedures - legislation & jurisprudence; Elective Surgical Procedures - statistics & numerical data; Elective Surgical Procedures - trends; Female; Fetal Macrosomia - epidemiology; Gestational Age; Humans; Intensive Care Units, Neonatal - statistics & numerical data; Labor, Induced - legislation & jurisprudence; Labor, Induced - statistics & numerical data; Labor, Induced - trends; Oregon - epidemiology; Patient Admission - statistics & numerical data; Perinatal Mortality; Pregnancy; Retrospective Studies; Stillbirth - epidemiology
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000001737

OBJECTIVE:To evaluate the association of Oregonʼs 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 (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. 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:Oregonʼs 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.