Why Do We Deliver? A Closer Look at Indicated Deliveries Scheduled Less Than 39 Weeks [28T

Abstract

INTRODUCTION: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires practice guidelines to eliminate elective near term deliveries. Our primary goal was to determine why practitioners continue to schedule non-elective (indicated) deliveries at less than 39 weeks. METHODS: A retrospective case series examined the incidence, indications, and outcomes for deliveries requested through our labor and delivery approval process from February 2013 thru July 2018. We analyzed these deliveries for indications, maternal demographics and neonatal outcomes between private and resident delivery services. RESULTS: Scheduled deliveries requested less than 39 weeks occurred for 450 viable pregnancies within 13,512 births (3.3%). Of these, 54% were by private obstetricians and 46% were by the resident service. The mean gestational age was 37.1 +/- 1.2 weeks (range 28.6 to 38.9 weeks). Frequency of key indications for delivery were intrauterine growth restriction 24.7% (n=111), hypertension related 14.9% (n=67), uncontrolled diabetes 13.3% (n=60), cholestasis 11.3% (n=51), multiple gestation 10.7% (n=48), other medical disorder 6.2% (n=28) and placenta previa 4.0% (n=18). NICU admissions occurred in 20.9% (94/450). Cesarean section occurred in 46%. There were no significant differences in demographics, indications, or frequency of NICU care in the private versus resident services. CONCLUSION: In an era of avoiding elective deliveries at less than 39 weeks, we found that approved, non-elective deliveries account for 3.3% of all births. Despite a mean gestational age of 37.1 weeks, NICU utilization is high at 20.9%. This series identifies opportunities for prospective studies to modify and reduce the neonatal risks within scheduled near term deliveries.