Top

Published in:

01-05-2015

Induction Rates and Delivery Outcomes After a Policy Limiting Elective Inductions

Authors: Kelly Yamasato, Marguerite Bartholomew, Marsha Durbin, Chieko Kimata, Bliss Kaneshiro

Published in: Maternal and Child Health Journal | Issue 5/2015

Abstract

The purpose of this study was to assess induction rates, maternal, and neonatal outcomes following adoption of a policy prohibiting elective inductions at less than 39 weeks gestation and inductions between 39 and 41 weeks with an unfavorable cervix. A retrospective cohort study of all deliveries greater than or equal to 37 weeks gestation was conducted 1 year prior to through 1 year after implementation of the induction policy. Induction rates before and after the policy were calculated as the primary outcome while maternal and neonatal conditions were assessed as secondary outcomes. Elective inductions (p = 0.016), elective inductions less than 39 weeks gestation (p = 0.020), and elective inductions 39–40 weeks and 6 days gestation with an unfavorable cervix (p = 0.031) decreased significantly following adoption of the policy. Maternal and neonatal outcomes, including rates of cesarean deliveries, postpartum hemorrhage, chorioamnionitis, and neonatal intensive care unit admissions remained unchanged, though this study was not adequately powered to detect differences in these outcomes. An institutional induction policy was associated with a reduction in elective inductions prior to 39 weeks and up to 40 weeks and 6 days with an unfavorable cervix. These reductions were not accompanied by change in maternal or neonatal outcomes at our institution.

Spong, C., Mercer, B. M., D’Alton, M., Kilpatrick, S., Blackwell, S., & Saade, G. (2011). Timing of indicated late-preterm and early-term birth. Obstetrics and Gynecology, 118, 323–333.CrossRefPubMedCentralPubMed

Cheng, Y., 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

Zhang, X., & Kramer, M. S. (2009). Variations in mortality and morbidity by gestational age among infants born at term. Journal of Pediatrics, 154, 358–362.CrossRefPubMed

Glantz, J. (2010). Term labor induction compared with expectant management. Obstetrics and Gynecology, 115, 70–76.CrossRefPubMed

Seyb, S., Berka, R. J., Socol, M. L., & Dooley, S. L. (1999). Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstetrics and Gynecology, 94, 600–607.CrossRefPubMed

Maslow, A., & Sweeny, A. L. (2000). Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstetrics and Gynecology, 95, 917–922.CrossRefPubMed

Murthy, K., Grobman, W. A., Lee, T. A., & Holl, J. L. (2011). Trends in induction of labor at early-term gestation. Obstetrics and Gynecology, 204, 435.e1–435.e6.

American College of Obstetricians and Gynecologists. (2009). ACOG practice bulletin no. 107: Induction of labor. Obstetrics and Gynecology, 114, 386–397.CrossRef

Oshiro, B., Kowalewski, L., Sappenfield, W., Alter, C. C., Bettegowda, V. R., Russel, R., et al. (2013). A multistate quality improvement program to decrease elective deliveries before 39 weeks of gestation. Obstetrics and Gynecology, 121, 1025–1031.CrossRefPubMed

10.

Oshiro, B., Henry, E., Wilson, J., Ware Branch, D., & 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.CrossRefPubMed

11.

Fisch, J., English, D., Pedaline, S., Brooks, K., & Simhan, H. N. (2009). Labor induction process improvement. Obstetrics and Gynecology, 113, 797–803.CrossRefPubMed

12.

Donovan, E. F., et al. (2010). The Ohio Perinatal Quality Collaborative Writing Committee. 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.

13.

Ehrenthal, D., Hoffman, M. K., Jiang, X., & Ostrum, G. (2011). Neonatal outcomes after implementation of guidelines limiting elective delivery before 39 weeks of gestation. Obstetrics and Gynecology, 118, 1047–1055.CrossRefPubMed

14.

Vrouenraets, F., Roumen, F. J. M. E., Dehing, C. J. G., van den Akker, E. S. A., Aarts, M. J. B., & Scheve, E. J. T. (2005). Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstetrics and Gynecology, 105, 690–697.CrossRefPubMed

15.

The Joint Commission [Internet]. AppendixATJC-Manual-Performance Measurement Network; c2012 [updated September 24, 2012; cited January 31, 2014]. https://manual.jointcommission.org/releases/TJC2013A/AppendixATJC.html#Table_Number_11_07_Conditions_Po

16.

Laughon, S., Zhang, J., Troendle, J., Sun, L., & Reddy, U. M. (2011). Using a simplified bishop score to predict vaginal delivery. Obstetrics and Gynecology, 117, 805–811.CrossRefPubMedCentralPubMed

17.

Vahratian, A., Zhang, J., Troendle, J. F., Sciscione, A. C., & Hoffman, M. K. (2005). Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstetrics and Gynecology, 105, 698–704.CrossRefPubMed

18.

Johnson, D. P., Davis, N. R., & Brown, A. J. (2003). Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix. American Journal of Obstetrics and Gynecology, 188, 1565–1569.CrossRefPubMed

19.

Osmundson, S., Ou-Yang, R., & Grobman, W. A. (2011). Elective induction compared with expectant management in nulliparous women with an unfavorable cervix. Obstetrics and Gynecology, 117, 583–587.CrossRefPubMed

20.

Caughey, A. B., Sundaram, V., Kaimal, A. J., Gienger, A., Cheng, Y. W., McDonald, K. M., et al. (2009). Systematic review: Elective induction of labor versus expectant management of pregnancy. Annals of Internal Medicine, 151, 252–263.CrossRefPubMed

21.

Goff, S., Pekow, P. S., Markenson, G., Knee, A., Chasan-Taber, L., & Lindenauer, P. K. (2012). Validity of using ICD-9-COM codes to identify selected categories of obstetric complications, procedures and comorbidities. Paediatric and Perinatal Epidemiology, 26, 421–429.CrossRefPubMed

Title: Induction Rates and Delivery Outcomes After a Policy Limiting Elective Inductions
Authors: Kelly Yamasato
Marguerite Bartholomew
Marsha Durbin
Chieko Kimata
Bliss Kaneshiro
Publication date: 01-05-2015
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue 5/2015
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-014-1612-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Induction Rates and Delivery Outcomes After a Policy Limiting Elective Inductions

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2015

I Am Pregnant and Want to Do Better But I Can’t: Focus Groups with Low-Income Overweight and Obese Pregnant Women

Prevalence of Prescription Medication Use Among Non-pregnant Women of Childbearing Age and Pregnant Women in the United States: NHANES, 1999–2006

Neighborhood Deprivation and Maternal Psychological Distress During Pregnancy: A Multilevel Analysis

Characteristics of Childbearing Women, Obstetrical Interventions and Preterm Delivery: A Comparison of the US and France

Variation in Pregnancy Intendedness Across U.S. Women’s Pregnancies

Antenatal Depressive Symptoms Associated with Specific Life Events and Sources of Social Support Among Italian Women