Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth

Am J Obstet Gynecol. 2010 Nov;203(5):449.e1-6. doi: 10.1016/j.ajog.2010.05.036. Epub 2010 Jul 8.


Objective: No studies exist that have examined the effectiveness of different approaches to a reduction in elective early term deliveries or the effect of such policies on newborn intensive care admissions and stillbirth rates.

Study design: We conducted a retrospective cohort study of prospectively collected data and examined outcomes in 27 hospitals before and after implementation of 1 of 3 strategies for the reduction of elective early term deliveries.

Results: Elective early term delivery was reduced from 9.6-4.3% of deliveries, and the rate of term neonatal intensive care admissions fell by 16%. We observed no increase in still births. The greatest improvement was seen when elective deliveries at <39 weeks were not allowed by hospital personnel.

Conclusion: Physician education and the adoption of policies backed only by peer review are less effective than "hard stop" hospital policies to prevent this practice. A 5% rate of elective early term delivery would be reasonable as a national quality benchmark.

Publication types

  • Comparative Study

MeSH terms

  • Analysis of Variance
  • Chi-Square Distribution
  • Female
  • Humans
  • Intensive Care Units, Neonatal*
  • Labor, Induced*
  • Practice Patterns, Physicians'*
  • Pregnancy
  • Retrospective Studies
  • Stillbirth*