Fewer unnecessary early deliveries seen in multistate, hospital-based study

USF Health faculty among authors of national study published in Obstetrics and Gynecology

Multistate, hospital-based quality improvement programs can be remarkably effective at reducing early elective deliveries of babies, a study published April 8 in the journal Obstetrics & Gynecology reports.

The March of Dimes, which partly funded the study, calls the findings good news, because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.

In the group of 25 participating hospitals, the rate of elective early-term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason before a baby reaches a full 39 weeks gestational age) fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.

Florida did even better than the other four states involved in the March of Dimes national project, said William Sappenfield, MD, MPH, director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the USF College of Public Health.  Dr. Sappenfield, co-chair of the March of Dimes prematurity initiative, and John Curran, MD, an associate vice president at USF Health and executive director of the Florida Perinatal Quality Collaborative (FPQC), were among the authors of the multistate study.

“The initiative coordinated by the FPQC at USF Health and the Chiles Center reduced the (early-term delivery) rate in Florida’s pilot hospitals to the same low national study rate of 5 percent, even though our state’s pilot hospitals started the initiative with a substantially higher rate of 38 percent,”  said Dr. Sappenfield.  “This would not have been possible without our partnership with the March of Dimes and our obstetrical consultants from Florida’s new district of the American Congress of Obstetricians and Gynecologists.”

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L to R: USF leaders of the Florida Perinatal Quality Collaborative include Linda Detman PhD, Department of Community and Family Health at the Chiles Center for Healthy Mothers and Babies; William Sappenfield, MD, MPH, director of the Chiles Center; and USF Health’s John Curran, MD, executive director of the FPQC.

“Reducing unnecessary early deliveries to less than 5 percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” said Edward R.B. McCabe, MD, medical director of the March of Dimes.  “This project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied. Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital’s overall preterm birth rate.”

The initiative focused on implementation of a toolkit called “Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age,” to guide changes in early term delivery practices.  The toolkit was developed in partnership with March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health.

This was the first project of a collaborative with perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Florida, Illinois, New York and Texas. These five states account for an estimated 38 percent of all births in the United States.

Florida hospitals participating in FPQC pilot study were St. Joseph’s Hospital in Tampa, Lee Memorial Health System in Ft. Myers, Plantation General Hospital in Plantation, Santa Rosa Medical Center in Milton, South Miami Hospital in Miami, and Broward General Medical Center in Ft. Lauderdale.

new born baby feet

The study targeted deliveries that were not medically necessary during the 37th and 38th week of fetal gestation. Even babies born just a few weeks early have higher rates of hospitalization and illness compared to full-term infants.

The six Florida hospitals participating in FPQC pilot study were St. Joseph’s Hospital in Tampa, Lee Memorial Health System in Ft. Myers, Plantation General Hospital in Plantation, Santa Rosa Medical Center in Milton, South Miami Hospital in Miami, and Broward General Medical Center in Ft. Lauderdale.  For an earlier story on USF’s role in the statewide, multihospital initiative, click here.

“This study is only the beginning,” said Dr. Sappenfield, a professor in the USF Department of Community and Family Health. “Not only do other hospitals in Florida need to reduce their rates of non-medically indicated deliveries, but this is the first of many needed perinatal quality improvement initiatives in Florida to assure that all our mothers and infants have access to quality health care.”

The FPQC, in coordination with hospitals, obstetricians, pediatricians, nurses and nurse midwives, is developing new statewide initiatives to reduce preterm births, avert infections and prevent maternal deaths.

The March of Dimes urges hospitals, health care providers, and patients to follow the American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own.  The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing.

“A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Bryan T. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology.

The March of Dimes is the leading nonprofit organization for pregnancy and baby health. With chapters nationwide and its premier event, March for Babies, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit marchofdimes.com or nacersano.org.

Anne DeLotto Baier of USF Health Communications contributed to this story.
Photo by Eric Younghans, USF Health Communications