From the Departments of Obstetrics and Gynecology and Internal Medicine, Christiana Care Health System, and Christiana Center for Outcomes Research, Newark, Delaware.
Obstet Gynecol. 2011 Nov;118(5):1047-1055. doi: 10.1097/AOG.0b013e3182319c58.
To evaluate the association of a new institutional policy limiting elective delivery before 39 weeks of gestation with neonatal outcomes at a large community-based academic center.
A retrospective cohort study was conducted to estimate the effect of the policy on neonatal outcomes using a before and after design. All term singleton deliveries 2 years before and 2 years after policy enforcement were included. Clinical data from the electronic hospital obstetric records were used to identify outcomes and relevant covariates. Multivariable logistic regression was used to account for independent effects of changes in characteristics and comorbidities of the women in the cohorts before and after implementation.
We identified 12,015 singleton live births before and 12,013 after policy implementation. The overall percentage of deliveries occurring before 39 weeks of gestation fell from 33.1% to 26.4% (P<.001); the greatest difference was for women undergoing repeat cesarean delivery or induction of labor. Admission to the neonatal intensive care unit (NICU) also decreased significantly; before the intervention, there were 1,116 admissions (9.29% of term live births), whereas after, there were 1,027 (8.55% of term live births) and this difference was significant (P=.044). However, an 11% increased odds of birth weight greater than 4,000 g (adjusted odds ratio 1.11; 95% confidence interval [CI] 1.01-1.22) and an increase in stillbirths at 37 and 38 weeks, from 2.5 to 9.1 per 10,000 term pregnancies (relative risk 3.67, 95% CI 1.02-13.15, P=.032), were detected.
A policy limiting elective delivery before 39 weeks of gestation was followed by changes in the timing of term deliveries. This was associated with a small reduction in NICU admissions; however, macrosomia and stillbirth increased.
评估在大型社区学术中心实施限制 39 周前选择性分娩的新机构政策与新生儿结局的关联。
采用回顾性队列研究，采用前后设计来估计该政策对新生儿结局的影响。纳入政策实施前 2 年和后 2 年所有足月单胎分娩。使用电子医院产科记录中的临床数据来识别结局和相关协变量。多变量逻辑回归用于解释实施前后队列中妇女特征和合并症的独立影响。
我们确定了政策实施前有 12015 例单胎活产，实施后有 12013 例。39 周前分娩的总体百分比从 33.1%降至 26.4%（P<.001）；差异最大的是再次剖宫产或引产的女性。新生儿重症监护病房（NICU）入院率也显著下降；干预前有 1116 例（足月活产的 9.29%），而之后有 1027 例（足月活产的 8.55%），差异有统计学意义（P=.044）。然而，出生体重大于 4000g 的几率增加了 11%（调整优势比 1.11；95%置信区间[CI] 1.01-1.22），并且在 37 周和 38 周时死产增加，每 10000 例足月妊娠中有 2.5 例增加至 9.1 例（相对风险 3.67，95%CI 1.02-13.15，P=.032）。
限制 39 周前选择性分娩的政策实施后，足月分娩的时间发生了变化。这与 NICU 入院率略有下降有关；然而，巨大儿和死产增加。
