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01-07-2012

Elective Delivery Before 39 Weeks: The Risk of Infant Admission to the Neonatal Intensive Care Unit

Authors: Claire A. Hoffmire, Patricia R. Chess, Taha Ben Saad, J. Christopher Glantz

Published in: Maternal and Child Health Journal | Issue 5/2012

Abstract

Despite American College of Obstetricians and Gynecologists guidelines suggesting that non-urgent planned deliveries be scheduled at/after 39 weeks; elective delivery before 39 weeks occurs often in the United States. The objective of this study is to estimate the elective delivery rate between 36^0/7 and 38^6/7 weeks gestation and compare NICU admission rates between elective and non-elective deliveries. We conducted a retrospective cohort (n = 1,577) study. Charts were reviewed for all singleton deliveries (2006–2007) between 36^0/7 and 38^6/7 weeks gestation taking place at one hospital in NYS to determine delivery status. We computed adjusted relative risks (RR) with 95% confidence intervals (CI) for elective delivery in relation to NICU admission using robust Poisson regression. 32.8% of all births were elective: 20.7% of vaginal and 55.7% of cesarean births. Elective delivery increased with increasing gestational age. After controlling for potential confounders, infants born via a vaginal elective delivery (RR = 1.40, CI: 1.00, 1.94), an elective cesarean (RR = 2.05, CI: 1.53, 2.76), or a non-elective cesarean (RR = 2.00, CI: 1.50, 2.66) are at significantly increased risk of NICU admission compared to infants born via a non-elective vaginal delivery. Elective delivery before 39 weeks is common and increases the risk of infant NICU admission.

Pollack, L. D., Ratner, I. M., & Lund, G. C. (1998). United States neonatology practice survey: Personnel, practice, hospital, and neonatal intensive care unit characteristics. Pediatrics, 101, 398–405.PubMedCrossRef

Gilbert, W. M., Nesbitt, T. S., & Danielsen, B. (2003). The cost of prematurity: Quantification by gestational age and birthweight. Obstetrics and Gynecology, 102, 488–492.PubMedCrossRef

Kramer, M. S., Demissie, K., Yang, H., Platt, R. W., Sauve, R., & Liston, R. (2000). The contribution of mild and moderate preterm birth to infant mortality. Fetal and infant health study group of the Canadian perinatal surveillance system. Journal of the American Medical Association, 284, 843–849.PubMedCrossRef

Young, P. C., Glasgow, T. S., Li, X., Guest-Warnick, G., & Stoddard, G. (2007). Mortality of late-preterm (near-term) newborns in Utah. Pediatrics, 119, e659–e665.PubMedCrossRef

Bastek, J. A., Sammel, M. D., Pare, E., Srinivas, S. K., Posencheg, M. A., & Elovitz, M. A. (2008). Adverse neonatal outcomes: Examining the risks between preterm, late preterm, and term infants. American Journal of Obstetrics and Gynecology, 199, 367.e1–367.e8.CrossRef

McIntire, D. D., & Leveno, K. J. (2008). Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstetrics and Gynecology, 111, 35–41.PubMedCrossRef

Shapiro-Mendoza, C. K., Tomashek, K. M., Kotelchuck, M., Barfield, W., Nannini, A., Weiss, J., et al. (2008). Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics, 121, e223–e232.PubMedCrossRef

Ramachandrappa, A., & Jain, L. (2009). Health issues of the late preterm infant. Pediatric Clinics of North America, 56, 565–577.PubMedCrossRef

Cheng, Y. W., Nicholson, J. M., Nakagawa, S., Bruckner, T. A., Washington, A. E., & Caughey, A. B. (2008). Perinatal outcomes in low-risk term pregnancies: Do they differ by week of gestation? American Journal of Obstetrics and Gynecology, 199, 370.e1–370.e7.CrossRef

10.

Davidoff, M. J., Dias, T., Damus, K., Russell, R., Bettegowda, V. R., Dolan, S., et al. (2006). Changes in the gestational age distribution among U.S. singleton births: Impact on rates of late preterm birth, 1992 to 2002. Seminars in Perinatology, 30, 8–15.PubMedCrossRef

11.

Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., Kirmeyer, S., et al. (2009). Births: Final data for 2006. National Vital Statistics Reports, 57, 1–102.

12.

ACOG Educational Bulletin. Assessment of fetal lung maturity: Number 230, November 1996. International Journal of Gynaecology and Obstetrics, 56, 191–198 (1997).

13.

Wilmink, F. A., Hukkelhoven, C. W., Lunshof, S., Mol, B. W., van der Post, J. A., & Papatsonis, D. N. (2010). Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: A 7-year retrospective analysis of a national registry. American Journal of Obstetrics and Gynecology, 202, 250.e1–250.e8.CrossRef

14.

Tita, A. T., Landon, M. B., Spong, C. Y., Lai, Y., Leveno, K. J., Varner, M. W., et al. (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. New England Journal of Medicine, 360, 111–120.PubMedCrossRef

15.

Gregory, K., Mongoue-Tchokote, S., McConnell, J., Morris, C., & Guise, J. (2008). Maternal and neonatal outcomes of planned primary cesarean versus vaginal delivery for low risk primiparous women at term. American Journal of Obstetrics and Gynecology, 199, S37.CrossRef

16.

Clark, S. L., Miller, D. D., Belfort, M. A., Dildy, G. A., Frye, D. K., & Meyers, J. A. (2009). Neonatal and maternal outcomes associated with elective term delivery. American Journal of Obstetrics and Gynecology, 200, 156.e1–156.e4.CrossRef

17.

The Joint Commission. (2011). Specifications manual for Joint Commission national quality core measures: Perinatal care. http://manual.jointcommission.org.

18.

ACOG Committee on Practice Bulletins. (2009). ACOG Practice Bulletin No. 107: Induction of labor. Obstetrics and Gynecology, 114, 386–397.CrossRef

19.

New York State Department of Health. (2006). Guidelines for the New York State certificate of live birth and quality improvement 2007.

20.

Zou, G. (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159, 702–706.PubMedCrossRef

21.

Spiegelman, D., & Hertzmark, E. (2005). Easy SAS calculations for risk or prevalence ratios and differences. American Journal of Epidemiology, 162, 199–200.PubMedCrossRef

22.

Barros, A. J. D., & Hirakata, V. N. (2003). Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio. BMC Medical Research Methodology, 3, 21.PubMedCrossRef

23.

Koopmans, C. M., Bijlenga, D., Groen, H., Vijgen, S. M. C., Aarnoudse, J. G., Bekedam, D. J., et al. (2009). Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): A multicenter, open-label randomized controlled trial. Lancet, 374, 979–988.PubMedCrossRef

24.

Glantz, J. C. (2003). Labor induction rate variation in upstate New York: What is the difference? Birth, 30, 168–174.PubMedCrossRef

25.

Donovan, E. F., Lannon, C., Bailit, J., Rose, B., Iams, J. D., Byczkowski, T., et al. (2010). A statewide initiative to reduce inappropriate scheduled births at 36(0/7)–38(6/7) weeks’ gestation. American Journal of Obstetrics and Gynecology, 202, 243.e1–243.e8.CrossRef

26.

Bailit, J. L., Gregory, K. D., Reddy, U. M., Gonzalez-Quintero, V. H., Hibbard, J. U., Ramirez, M. M., et al. (2010). Maternal and neonatal outcomes by labor onset type and gestational age. American Journal of Obstetrics and Gynecology, 202, 245.e1–245.e12.CrossRef

27.

Oshiro, B. T., Henry, E., Wilson, J., Branch, D. W., & Varner, M. W. (2009). Women and newborn clinical integration program. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstetrics and Gynecology, 113, 804–811.PubMed

28.

Nicholl, M. C., & Cattell, M. A. (2010). Getting evidence into obstetric practice: Appropriate timing of elective caesarean section. Australian Health Review, 34, 90–92.PubMedCrossRef

29.

Fisch, J. M., English, D., Pedaline, S., Brooks, K., & Simhan, H. N. (2009). Labor induction process improvement: A patient quality-of-care initiative. Obstetrics and Gynecology, 113, 797–803.PubMed

30.

Luo, G., & Norwitz, E. R. (2008). Revisiting amniocentesis for fetal lung maturity after 36 weeks’ gestation. Review in Obstetrics and Gynecology, 1, 61–68.

Title: Elective Delivery Before 39 Weeks: The Risk of Infant Admission to the Neonatal Intensive Care Unit
Authors: Claire A. Hoffmire
Patricia R. Chess
Taha Ben Saad
J. Christopher Glantz
Publication date: 01-07-2012
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue 5/2012
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-011-0830-9

At a glance: The STEP trials

Springer Medicine

Elective Delivery Before 39 Weeks: The Risk of Infant Admission to the Neonatal Intensive Care Unit

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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