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58: Impact of delaying term delivery on stillbirth rate

      Objective

      In 2010 The Joint Commission (JC) introduced the rate of elective deliveries <39 weeks gestation as an institutional quality measure. We evaluated the effect of this policy on the stillbirth rate among women undergoing induction of labor.

      Study Design

      We performed a retrospective cohort study using Washington State birth and death certificate data linked to hospital discharge ICD9 codes for all women undergoing an induction of labor at ≥37 weeks gestation. Stillbirth rates before (Group 1: 2005-2008) and after (Group 2: 2011) policy implementation were calculated, while controlling for maternal age, BMI, ethnicity, parity, and smoking. We then stratified outcomes by presence or absence of JC indications for early induction. Secondary outcomes of gestational age, mode of delivery and neonatal outcomes were evaluated before and after policy change. Chi-squared, ttest, and regression models were used as appropriate.

      Results

      We identified 84,226 subjects in Group 1 and 20,711 in Group 2. Groups differed by pregnancy characteristics (Table 1). Gestational age of delivery was delayed (Table 1) and cesarean delivery rate was unchanged (Group 1: 19.4% v. Group 2: 19.2%, p=0.14) after policy implementation. The overall stillbirth rate significantly increased from 1.5/1000 births (Group 1) to 2.5/1000 (Group 2), p<0.001. This increased stillbirth rate persisted with exclusion of JC indications for early delivery (1.9/1000 compared to 4.5/1000, p<0.001). Policy implementation did not impact the indicated delivery stillbirth rate (1.2/1000 v. 1.5/1000, p=0.31). Neonatal mortality did not change with policy implementation (Table 1) nor did neonatal length of stay (Group 1: 1.8 days v. Group 2: 1.9 days, p=0.03).

      Conclusion

      Rate of stillbirth among women with an induction of labor increased after implementation of policy to delay induction and persisted after exclusion of indicated deliveries. Among women with indicated deliveries, the stillbirth rate did not change after policy implementation, despite shift to later gestational age of delivery.
      Tabled 1Demographic characteristics and obstetric outcomes of women undergoing induction of labor at term by birth year and elective or indicated JACO indication
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      *Adjusted for maternal age, maternal, BMI, smoking, and maternal ethnicity.