Objective:  Twenty-seven hospitals of a large, multi-hospital system identified the need to quantify the frequency of elective deliveries at less than 39 completed weeks of gestation and to determine if there were associated adverse maternal and or neonatal outcomes.

Project Design:  The design of the project was a prospective observational study.  Level 1, 2, and 3 perinatal services from twenty-one states participated in the study.  Representatives from participating hospitals collected and reported data on a weekly basis from May 1 through July 31, 2007.

Project Results:  Of 17, 794 deliveries, 14, 955 (84%) occurred at 37 weeks of gestation or greater.  Of term deliveries, 6562  (44%) were planned induction or cesarean sections rather than spontaneous deliveries.  Among the planned deliveries, 4645 (71%) were purely elective.  17.8% of infants delivered electively without medical indication at 37-38 weeks gestation.  Eight percent of those delivered electively at 38-39 weeks gestation required admission to a newborn special care unit, compared to 4.6% of infants delivered at 39 weeks or beyond (p<.001).  The average special care time for these infants was 4.5 days.  Cesarean delivery rate in women undergoing induction of labor was not influenced by gestational age, but was highly influenced by initial cervical dilatation and parity.  Cervical dilatation ranged from 0% for parous women induced at 5 cm or greater to 50% for nulliparous women at 0 cm.

Conclusions and Lessons Learned:  Elective delivery prior to 39 weeks gestation is associated with significant neonatal morbidity.  Initial cervical dilatation is highly correlated with cesarean delivery among women undergoing induction of labor in both nulliparous and parous women.  Elective delivery prior to 39 completed weeks gestation is not recommended.  These study findings should be shared with physicians and nurses responsible for the care of pregnant women who are making decisions regarding elective induction or cesarean section.  Women contemplating elective induction at 39 weeks gestation with an unfavorable cervix should be counseled regarding an increased rate of cesarean delivery and the potential for an adverse neonatal outcome.

Future Directions:  The findings of this study have been shared with hospital administrators, maternal and newborn physicians and nurses of the hospital system.  An article sharing the findings has been accepted for publication in a leading medical journal.  To minimize the frequency of inappropriate elective inductions and cesarean sections and decrease adverse maternal and neonatal outcomes, obstetrical and neonatal clinicians representing system hospitals will collaborate to develop and implement guidelines related to elective delivery.  Educational programs will be created to share with health care team members, hospital administrators, and patients and families.  Processes to collect and monitor elective delivery data and maternal and neonatal outcomes will be established and implemented.