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.
Clark, Steven L. MD; Frye, Donna R. RN, MN; Meyers, Janet A. RN; Belfort, Michael A. MD, PhD; Dildy, Gary A. MD; Kofford, Shalece RN, MPH; Englebright, Jane RN, PhD; Perlin, Jonathan A. MD, PhD
[Miscellaneous Article] American Journal of Obstetrics & Gynecology. 203(5):449e1-449e6, November 2010.

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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.

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