US Hospitals Move to Shut Down Elective Deliveries

New studies show that recent policies aimed at eliminating nonmedically indicated deliveries prior to 39 weeks of gestation might be having a positive impact on fetal outcomes.

The first study, a retrospective analysis involved 18,503 women who had given birth at Summa Akron City Hospital (OH, USA), revealed that a "hard-stop" policy to prevent elective delivery prior to 39 weeks resulted in a significant reduction in still births, from 16 in the 3 years before the policy was instituted to three in the 2.5 years afterward. Additionally, there was a decline in the number of neonatal intensive care unit (NICU) admissions, from 867 before the policy to 587 afterward, but that trend did not reach significance.

The second study, by researchers at the University of Pennsylvania (Philadelphia, USA), involved a survey of 2,641 US hospitals with labor and delivery units. The researchers found that 66.5% of the 2,367 responding hospitals reported having a formal policy restricting elective deliveries. Of the hospitals without a formal policy, 53% said that nonmedically indicated deliveries were against their standard of care. Of the hospitals with a formal policy, 69% said they had a strictly enforced hospital "hard-stop" policy against nonmedically indicated deliveries less at fewer than 39 weeks. Both studies were presented at the annual meeting of the American Congress of Obstetricians and Gynecologists (ACOG), held during May 2013 in New Orleans (LA, USA).

“Hospital policies have been shown to be one effective tool in reducing the incidence of nonmedically indicated deliveries,” concluded lead author Nathaniel DeNicola, MD, and colleagues of the University of Pennsylvania. “There is reason to be encouraged that hospital policies are decreasing the frequency of this practice, and we expect that fewer elective deliveries prior to 39 weeks means fewer term babies going to the NICU.”

Elective deliveries involve a caesarean section, performed on the basis of an obstetrical or medical indication or at the request of the pregnant patient.

Related Links:
Summa Akron City Hospital
University of Pennsylvania