Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries: Association With Obstetric Procedure Use and Health Outcomes.
Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries: Association With Obstetric Procedure Use and Health Outcomes.
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DOI：
10.1097/aog.0000000000001737
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发表时间：
2016-12
影响因子：
7.2
通讯作者：
Caughey AB
中科院分区：
文献类型：
--
作者：
Snowden JM;Muoto I;Darney BG;Quigley B;Tomlinson MW;Neilson D;Friedman SA;Rogovoy J;Caughey AB
评估俄勒冈州限制早期选择性分娩（妊娠39周前）的硬停政策与选择性早期引产率和剖宫产率以及相关母婴结局之间的关系。这是一项基于人口的回顾性队列研究，使用生命统计数据和多变量logistic回归模型，对2008年至2013年俄勒冈州的出生率进行分析。我们的风险敞口是俄勒冈州的硬停政策，定义为政策前（2008 - 2010年）和政策后（2012 - 2013年）的时间段。我们纳入了所有足月或过期、头位、非异常、单胎分娩（N= 181，034例分娩）。我们的主要结局是在妊娠37或38周时进行引产和剖宫产，出生证明上没有记录的指征（即，选择性早期分娩）。次要结局包括新生儿重症监护室入院、死产、巨大儿、绒毛膜炎和新生儿死亡。孕39周前选择性引产率从政策前的4.0%下降到政策后的2.5%（P<0.001）;选择性早期剖宫产率也有类似的下降（从3.4%下降到2.1%; P<0.001）。新生儿重症监护室入院、死产或辅助通气治疗前后无变化，但绒毛膜炎确实增加（从1.2%增加到2.2%，P<0.001;校正比值比为1.94，95%置信区间为1.80 - 2.09）。俄勒冈州限制选择性早期分娩的全州政策与选择性早期分娩的减少有关，但没有改善孕产妇或新生儿的结局。虽然俄勒冈州的硬停政策与减少选择性早期分娩，几个围产期的结果并没有不同的政策前和政策后的时期。
To evaluate the association of Oregon’s hard-stop policy limiting early elective deliveries (before 39 weeks of gestation) and the rate of elective early-term inductions and cesarean deliveries and associated maternal–neonatal outcomes. This was a population-based retrospective cohort study of Oregon births between 2008 and 2013, using vital statistics data and multivariable logistic regression models. Our exposure was the Oregon hard-stop policy, defined as the time periods pre-policy (2008 – 2010) and post-policy (2012 – 2013). We included all term or postterm, cephalic, nonanomalous, singleton deliveries (N= 181,034 births). Our primary outcomes were induction of labor and cesarean delivery at 37 or 38 weeks of gestation without a documented indication on the birth certificate (i.e., elective early term delivery). Secondary outcomes included neonatal intensive care unit admission, stillbirth, macrosomia, chorioamnionitis, and neonatal death. The rate of elective inductions before 39 weeks declined from 4.0% in the prepolicy period to 2.5% during the postpolicy period (P<0.001); a similar decline was observed for elective early term cesareans (from 3.4% to 2.1%; P<0.001). There was no change in neonatal intensive care unit admission, stillbirth, or assisted ventilation pre-policy and post-policy, but chorioamnionitis did increase (from 1.2% to 2.2%, P<0.001; adjusted odds ratio, 1.94, 95% confidence interval, 1.80 – 2.09). Oregon’s statewide policy to limit elective early-term delivery was associated with a reduction in elective early-term deliveries, but no improvement in maternal or neonatal outcomes. Although Oregon’s hard-stop policy was associated with a reduction in elective early-term deliveries, several perinatal outcomes do not differ between the pre-policy and post-policy periods.