Berrien Kate, Devente James, French Amanda, Cochran Keith M, McCaffrey Marty, Horton Bethany J, Chescheir Nancy
Perinatal Quality Collaborative of North Carolina, Chapel Hill, NC, USA; Community Care of North Carolina, Raleigh, NC, USA.
Perinatal Quality Collaborative of North Carolina, Chapel Hill, NC, USA; Brody School of Medicine, East Carolina University, Greenville, NC, USA.
N C Med J. 2014 May-Jun;75(3):169-76. doi: 10.18043/ncm.75.3.169.
Despite long-standing guidelines from the American College of Obstetricians and Gynecologists that call for avoiding elective births prior to 39 weeks of gestation, elective deliveries make up almost one-third of US births occurring in weeks 36-38. Poor outcomes are more likely for infants born electively before 39 weeks than for those born at 39 weeks. The Perinatal Quality Collaborative of North Carolina (PQCNC) undertook the 39 Weeks Project in 2009-2010 with the aim of reducing the number of early-term elective deliveries in North Carolina hospitals.
Participating hospitals (N = 33) provided retrospective data on all early-term deliveries and created new policies, or amended or enforced existing policies, to accomplish the project's goals. Project activities included in-person learning sessions, regional meetings, webinars, electronic newsletters, a secure extranet Web site where participating hospitals could share relevant materials, and individual leadership consultations with hospital teams. Hospitals submitted monthly data to PQCNC, which provided ongoing training and data analysis.
Elective deliveries before 39 weeks of gestation decreased 45% over the project period, from 2% to 1.1% of all deliveries. The proportion of elective deliveries among all scheduled early-term deliveries also decreased, from 23.63% to 16.19%. There was an increase in the proportion of patients with documented evidence of medical indications for early delivery, from 62.4% to 88.2%.
No data were collected to determine whether outcomes changed for patients whose deliveries were deferred. The project also depended on each hospital to code its own data.
The PQCNC's 39 Weeks Project successfully decreased the rate of early-term elective deliveries in participating hospitals.
尽管美国妇产科医师学会长期以来一直发布指南，呼吁避免在妊娠39周前进行选择性分娩，但在36 - 38周出生的美国婴儿中，选择性分娩几乎占三分之一。与39周出生的婴儿相比，39周前选择性出生的婴儿出现不良结局的可能性更大。北卡罗来纳州围产期质量协作组织（PQCNC）在2009 - 2010年开展了“39周项目”，旨在减少北卡罗来纳州医院早期选择性分娩的数量。
参与项目的医院（共33家）提供了所有早期分娩的回顾性数据，并制定了新政策，或修订或执行现有政策，以实现项目目标。项目活动包括面对面学习课程、区域会议、网络研讨会、电子通讯、一个安全的外联网网站（参与项目的医院可在该网站上分享相关资料）以及与医院团队进行的个人领导力咨询。医院每月向PQCNC提交数据，PQCNC则提供持续培训和数据分析。
在项目期间，妊娠39周前的选择性分娩减少了45%，从占所有分娩的2%降至1.1%。所有计划性早期分娩中选择性分娩的比例也有所下降，从23.63%降至16.19%。有医学指征证明需提前分娩的患者比例有所增加，从62.4%增至88.2%。
未收集数据以确定分娩推迟的患者结局是否发生变化。该项目还依赖于每家医院自行对其数据进行编码。
PQCNC的“39周项目”成功降低了参与项目医院的早期选择性分娩率。
