Elective Delivery Before 39 Weeks: The Risk of Infant Admission to the Neonatal Intensive Care Unit
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Despite American College of Obstetricians and Gynecologists guidelines suggesting that non-urgent planned deliveries be scheduled at/after 39 weeks; elective delivery before 39 weeks occurs often in the United States. The objective of this study is to estimate the elective delivery rate between 360/7 and 386/7 weeks gestation and compare NICU admission rates between elective and non-elective deliveries. We conducted a retrospective cohort (n = 1,577) study. Charts were reviewed for all singleton deliveries (2006–2007) between 360/7 and 386/7 weeks gestation taking place at one hospital in NYS to determine delivery status. We computed adjusted relative risks (RR) with 95% confidence intervals (CI) for elective delivery in relation to NICU admission using robust Poisson regression. 32.8% of all births were elective: 20.7% of vaginal and 55.7% of cesarean births. Elective delivery increased with increasing gestational age. After controlling for potential confounders, infants born via a vaginal elective delivery (RR = 1.40, CI: 1.00, 1.94), an elective cesarean (RR = 2.05, CI: 1.53, 2.76), or a non-elective cesarean (RR = 2.00, CI: 1.50, 2.66) are at significantly increased risk of NICU admission compared to infants born via a non-elective vaginal delivery. Elective delivery before 39 weeks is common and increases the risk of infant NICU admission.
KeywordsElective delivery Non-indicated delivery Non-urgent delivery Neonatal morbidity Scheduled birth
- 3.Kramer, M. S., Demissie, K., Yang, H., Platt, R. W., Sauve, R., & Liston, R. (2000). The contribution of mild and moderate preterm birth to infant mortality. Fetal and infant health study group of the Canadian perinatal surveillance system. Journal of the American Medical Association, 284, 843–849.PubMedCrossRefGoogle Scholar
- 11.Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., Kirmeyer, S., et al. (2009). Births: Final data for 2006. National Vital Statistics Reports, 57, 1–102.Google Scholar
- 12.ACOG Educational Bulletin. Assessment of fetal lung maturity: Number 230, November 1996. International Journal of Gynaecology and Obstetrics, 56, 191–198 (1997).Google Scholar
- 13.Wilmink, F. A., Hukkelhoven, C. W., Lunshof, S., Mol, B. W., van der Post, J. A., & Papatsonis, D. N. (2010). Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: A 7-year retrospective analysis of a national registry. American Journal of Obstetrics and Gynecology, 202, 250.e1–250.e8.CrossRefGoogle Scholar
- 17.The Joint Commission. (2011). Specifications manual for Joint Commission national quality core measures: Perinatal care. http://manual.jointcommission.org.
- 19.New York State Department of Health. (2006). Guidelines for the New York State certificate of live birth and quality improvement 2007.Google Scholar
- 23.Koopmans, C. M., Bijlenga, D., Groen, H., Vijgen, S. M. C., Aarnoudse, J. G., Bekedam, D. J., et al. (2009). Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): A multicenter, open-label randomized controlled trial. Lancet, 374, 979–988.PubMedCrossRefGoogle Scholar
- 30.Luo, G., & Norwitz, E. R. (2008). Revisiting amniocentesis for fetal lung maturity after 36 weeks’ gestation. Review in Obstetrics and Gynecology, 1, 61–68.Google Scholar