Mandated preterm delivery: its prevalence and impact at a tertiary care center

Abstract

Objective: To determine the prevalence and impact of mandated preterm deliveries at a tertiary care center.Methods: A review of all livebirths at less than 37 weeks of gestation was conducted between January 1998 and August 1999 at our institution. Mandated delivery was defined as intentional intervention because of a deteriorating maternal or fetal condition. Maternal demographics, reasons for intervention, and intrapartum courses were compared with two other preterm groups (spontaneous ruptured membranes, spontaneous labor) delivering during the same period.Results: A total of 667 (11.2%) pregnancies delivered preterm, with 102 of these cases (15.3%) being mandated. Primary reasons for mandated delivery were worsening of preeclampsia (69%), vaginal bleeding (13%), severe growth restriction or major malformation (7%), and other maternal medical illness (11%). Delivery at less than 34 weeks of gestation, with a greater need for intensive care nursery admission, was more common in the mandated group (68.6%) than in the ruptured membranes (41.2%; P <0.005), or in the spontaneous labor group (46.5%; P <0.01). Overall cesarean delivery rates were higher in the mandated group (69.6%) than in the ruptured membranes group (18.4%; P <0.001) and in the spontaneous labor group (21.5%; P <0.001). The presence of an unfavorable cervix and the need to expedite delivery explained the high rate of surgery.Conclusion: Conditions mandating delivery account for 15% of all preterm births and are associated with a greater need for cesarean delivery and delivery before 34 weeks of gestation.