‘Hard-Stop’ Policy Nearly Eliminates NICU Admissions from Elective Inductions

May 7, 2013

New Orleans, LA -- “Hard-stop” policies against elective deliveries until 39 weeks’ gestation result in fewer early-term infants admitted to the NICU, according to new research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists.

Like most US hospitals, elective induction had become common at Memorial Regional Hospital, one of three obstetric hospitals in the Hollywood, FL-based Memorial Healthcare System. In 2010, Memorial Regional began strongly discouraging the practice of elective inductions, which is considered a “soft stop.” The following year, the hospital instituted a “hard-stop” policy, which meant that doctors could not perform elective deliveries prior to 39 weeks without the approval of the obstetrics chief.

L. Laurie Scott, MD, and Virginia Kline Kaye, RNC, of Memorial Regional, studied the effect that soft-stop and hard-stop policies had on the number of infants delivered at the hospital prior to 39 weeks’ gestation, as well as the number of NICU admissions. Using hospital records, the researchers identified elective deliveries before 39 weeks and NICU admissions from those deliveries before and after the soft-stop policy began and after the hard-stop policy.

The percentage of infants electively delivered before 39 weeks declined over the three time periods, with an initial decrease during the soft-stop period and a further decrease in the hard-stop period. In 2009, before the soft-stop policy, the percentage of infants electively delivered at Memorial Regional Hospital before 39 weeks was 14.7%. In 2010, with a soft-stop policy in place, the percentage fell to 10.3%. The following year, with a hard-stop policy in place, it dropped to 1.1%. In 2012, two years after the hard-stop policy, it dropped to 0.03%. 

“The trend was definitely toward improvement even with the soft stop,” said Dr. Scott. “And the longer the soft stop was in place, the better it got, but the hard stop resulted in the lowest number.” 

The number of infants electively delivered before 39 weeks and consequently admitted to the NICU also declined substantially between the time periods, from 82 to 0. Over time, researchers also noted a decreasing need for NICU admission for infants being delivered before 39 weeks.

“This provides additional support for the current recommendations to delay elective delivery until 39 weeks or later,” Dr. Scott said. “Delaying elective deliveries before 39 weeks may be inconvenient for the patient and her physician in some cases, but the prevention of NICU admissions and newborn health problems, and possibly long-term morbidity, is significant.”

*Tuesday Poster #69: The “Hard Stop”: Decreasing Elective Deliveries and NICU Admissions Before 39 Weeks

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.


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