Oversight of elective early term deliveries: avoiding unintended consequences

Published:August 22, 2011DOI:
      The national movement to eliminate elective delivery at <39 weeks' gestation has engendered much enthusiasm and is a major step forward in the evolution of perinatal patient safety. Our experience with >1 million births in the past 5 years suggests the existence of a number of potential pitfalls that should be considered in policy development, enforcement, and compliance monitoring. Attention to these details will ensure continued patient benefit from these policies without endangering those fetuses in whom early term delivery is warranted medically.

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        • Clark S.L.
        • Miller D.D.
        • Belfort M.A.
        • Dildy G.A.
        • Frye D.K.
        • Meyers J.A.
        Neonatal and maternal outcomes associated with elective term delivery.
        Am J Obstet Gynecol. 2009; 200: 156.e1-156.e4
        • Clark S.L.
        • Frye D.R.
        • Meyers J.A.
        • et al.
        Reduction in elective delivery prior to 39 weeks gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal outcome and stillbirth.
        Am J Obstet Gynecol. 2010; 203: 449.e1-449.e6
        • Tita A.T.
        • Landon M.B.
        • Spong C.Y.
        • et al.
        Timing of elective repeat cesarean delivery at term and neonatal outcomes.
        N Engl J Med. 2009; 360: 111-120
        • Fleishman A.R.
        • Oinuma M.
        • Clark S.L.
        Rethinking the definition of “term pregnancy.”.
        Obstet Gynecol. 2010; 116: 136-139
        • Reddy U.M.
        • Bettegowda V.R.
        • Dias T.
        • et al.
        Term pregnancy: a period of heterogeneous risk for infant mortality.
        Obstet Gynecol. 2011; 117: 1179-1187
        • Kamath B.D.
        • Morcotte M.P.
        • DeFranco E.A.
        Neonatal morbidity after documented fetal lung maturity in late preterm and early term infants.
        Am J Obstet Gynecol. 2011; 204: 518.e1-518.e8
        • Iams J.
        • Ohio Perinatal Quality Collaborative
        A statewide initiative to reduce scheduled births without appropriate indication.
        Am J Obstet Gynecol. 2009; 201: S19
        • Oshiro B.T.
        • Henry E.
        • Wilson J.
        • Branch D.W.
        • Varner M.W.
        Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system.
        Obstet Gynecol. 2009; 113: 804-811
        • American College of Obstetricians and Gynecologists
        Practice bulletin no. 107.
        Obstet Gynecol. 2009; 114: 386-397
        • March of Dimes
        Elective delivery between 37 and 39 weeks gestation.
        (Accessed July 19, 2011)
        • The National Quality Forum. NQF #0469
        Elective delivery prior to 39 completed weeks gestation.
        (Endorsed on: October 28, 2008) (Accessed Nov. 9, 2009)
      1. The Joint Commission introduces perinatal care core measures.
        (Accessed Jan. 12, 2010)
        • ABC News
        Texas Medicaid would restrict some elective deliveries to lower NICU costs.
        (Accessed July 19, 2011)
        • Reddy U.M.
        • Ko C.W.
        • Willinger M.
        “Early” term births (37-38 weeks) are associated with increased mortality.
        Am J Obstet Gynecol. 2006; 195: S202
        • Clark S.L.
        • Fleishman A.R.
        Term pregnancy: time for a re-definition.
        Clin Perinatol. 2011; 38: 557-564
        • Spong C.Y.
        • Mercer B.M.
        • D'Alton M.
        • et al.
        Timing of indicated late-preterm and early-term births.
        Obstet Gynecol. 2011; 118: 323-333