Oregon`s `hard-stop` policy may have reduced elective early-term deliveries

By Reuters Staff

NEW YORK (Reuters Health) - Implementation of Oregon's "hard-stop" policy in 2011 was followed by a reduction in elective early-term deliveries but not by improvements in maternal or neonatal outcomes, according to a retrospective study.

Campaigns at various levels have aimed to limit elective early-term deliveries, but Oregon became the first state to implement a hard-stop policy that requires review and approval for any delivery without documented indication before 39 weeks' gestation.

Dr. Jonathan M. Snowden from Oregon Health & Science University, Portland, and colleagues evaluated the effect of the new policy on the rate of elective early-term inductions and Cesarean deliveries, as well as associated maternal and neonatal outcomes.

Their report included 111,292 deliveries before and 69,742 after implementation of the policy.

The proportion of elective inductions before 39 weeks' gestation declined from 4.0% before the policy to 2.5% after the policy (p

The magnitude of decrease for elective early-term induction was more pronounced in multiparous women (a 43% decrease from 4.4% to 2.5%) than in nulliparous women (a 27% decrease from 3.4% to 2.5%).

The decreases continued to be statistically significant in multivariable models that adjusted for various confounders.

"The fact that Oregon's hard-stop policy decreased elective early-term delivery is especially notable given the fact that the baseline rate of elective early-term delivery in Oregon was well below the national average," the researchers note.

The odds of stillbirth, neonatal death, neonatal seizures, NICU admissions, and assisted ventilation were similar before and after implementation of the policy, whereas the odds of maternal blood transfusion and chorioamnionitis and of 5-minute Apgar scores less than 4 increased significantly after implementation of the policy.

"This lack of association between rates of elective early-term delivery and perinatal morbidity corroborates a recent study, which found no association between these outcomes," the authors conclude. "Collectively, these findings raise the question of whether elective early-term delivery is a meaningful marker for quality of obstetric care, that is, one that predicts maternal and neonatal morbidity."

Dr. Snowden did not respond to a request for comments.

SOURCE: https://bit.ly/2gOJakr

Obstet Gynecol 2016.