All ETDs from UAB

Advisory Committee Chair

Janet Bronstein

Advisory Committee Members

Justin Blackburn

Russell Kirby

Alan Tita

Martha Wingate

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Non-medically indicated deliveries, resulting from obstetrical intervention in an effort to avoid delivery at a later date, are frequently referred to as elective deliveries. These were increasingly occurring in early term gestations of 37.0 to 38.7 and frequently resulting in adverse neonatal outcomes such as sepsis, hypoglycemia, respiratory distress disorder the need for mechanical ventilation. In addition to concerns regarding adverse neonatal and maternal health outcomes, elective early term delivery increases health care costs due to prolonged hospital stays and NICU admissions. Efforts taken to reduce elective early term deliveries include public service announcements, educational programs, performance incentives and reimbursement restrictions. These programs and policies have been met with some resistance due to concerns that an inadvertent increase in fetal demise might occur. Debate continues over whether perinatal outcomes are improved or worsen as a result of elective early term deliveries. This dissertation research project examines several issues regarding elective early term delivery. A systematic review of the evidence summarizes the literature by study design and comparison group. Next, socio-demographic characteristics and medical indications associated with early term delivery were investigated. Finally, data sources were compared for sensitivity in the ability to identify medical indication. Neonatal outcomes for non-medically indicated early term delivery were assessed by data source. Results demonstrated a greater odds of neonatal mortality and morbidity for non-medically indicated early term delivery as compared to full term deliveries without medical indications regardless of data source.

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