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Am J Perinatol 2016; 33(10): 1008-1016
DOI: 10.1055/s-0036-1582129
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Center Variation in the Delivery of Indicated Late Preterm Births

Sofia Aliaga
1   Department of Pediatrics, The University of North Carolina, Chapel Hill, North Carolina
,
Jun Zhang
2   MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Minhang District, Shanghai, China
,
D. Leann Long
3   Department of Biostatistics, West Virginia University, Morgantown, West Virginia
,
Amy H. Herring
3   Department of Biostatistics, West Virginia University, Morgantown, West Virginia
4   Carolina Population Center, Chapel Hill, North Carolina
,
Matthew Laughon
1   Department of Pediatrics, The University of North Carolina, Chapel Hill, North Carolina
,
Kim Boggess
5   Department of Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, North Carolina
,
Uma M. Reddy
6   Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Katherine Laughon Grantz
7   Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
› Author Affiliations
Further Information

Publication History

28 May 2015

24 February 2016

Publication Date:
27 April 2016 (online)

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Abstract

Objective Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births.

Study design We performed an analysis of singleton late preterm and term births from a large U.S. retrospective obstetrical cohort. Births associated with spontaneous preterm labor, major congenital anomalies, chorioamnionitis, and emergency cesarean were excluded. We used modified Poisson fixed effects logistic regression with interaction terms to assess center variation of indicated late preterm births associated with four medical/obstetric comorbidities after adjusting for socio-demographics, comorbidities, and hospital/provider characteristics.

Results We identified 150,055 births from 16 hospitals; 9,218 were indicated late preterm births. We found wide variation of indicated late preterm births across hospitals. The extent of center variation was greater for births associated with preterm premature rupture of membranes (risk ratio [RR] across sites: 0.45–3.05), hypertensive disorders of pregnancy (RR across sites: 0.36–1.27), and placenta previa/abruption (RR across sites: 0.48–1.82). We found less center variation for births associated with diabetes (RR across sites: 0.65–1.39).

Conclusion Practice variation in the management of indicated late preterm deliveries might be a source of preventable late preterm birth.

Keywords

late preterm birth - preterm birth - center variation - practice variation
 

  • References

  • 1 Hamilton BE, Martin JA, Osterman M, Curtin SC. Births: preliminary data for 2013. Natl Vital Stat Rep 2014; 63 (2)
    PubMedGoogle Scholar
  • 2 Engle WA, Tomashek KM, Wallman C ; Committee on Fetus and Newborn, American Academy of Pediatrics. “Late-preterm” infants: a population at risk. Pediatrics 2007; 120 (6) 1390-1401
    CrossrefPubMedGoogle Scholar
  • 3 Bird TM, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics 2010; 126 (2) e311-e319
    CrossrefPubMedGoogle Scholar
  • 4 Bérard A, Le Tiec M, De Vera MA. Study of the costs and morbidities of late-preterm birth. Arch Dis Child Fetal Neonatal Ed 2012; 97 (5) F329-F334
    CrossrefPubMedGoogle Scholar
  • 5 Escobar GJ, Greene JD, Hulac P , et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90 (2) 125-131
    CrossrefPubMedGoogle Scholar
  • 6 Morse SB, Zheng H, Tang Y, Roth J. Early school-age outcomes of late preterm infants. Pediatrics 2009; 123 (4) e622-e629
    CrossrefPubMedGoogle Scholar
  • 7 Petrini JR, Dias T, McCormick MC, Massolo ML, Green NS, Escobar GJ. Increased risk of adverse neurological development for late preterm infants. J Pediatr 2009; 154 (2) 169-176
    CrossrefPubMedGoogle Scholar
  • 8 Chyi LJ, Lee HC, Hintz SR, Gould JB, Sutcliffe TL. School outcomes of late preterm infants: special needs and challenges for infants born at 32 to 36 weeks gestation. J Pediatr 2008; 153 (1) 25-31
    CrossrefPubMedGoogle Scholar
  • 9 Teune MJ, Bakhuizen S, Gyamfi Bannerman C , et al. A systematic review of severe morbidity in infants born late preterm. Am J Obstet Gynecol 2011; 205 (4) 374.e1-374.e9
    CrossrefPubMedGoogle Scholar
  • 10 Laughon SK, Reddy UM, Sun L, Zhang J. Precursors for late preterm birth in singleton gestations. Obstet Gynecol 2010; 116 (5) 1047-1055
    CrossrefPubMedGoogle Scholar
  • 11 Reddy UM, Ko CW, Raju TN, Willinger M. Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatrics 2009; 124 (1) 234-240
    CrossrefPubMedGoogle Scholar
  • 12 Holland MG, Refuerzo JS, Ramin SM, Saade GR, Blackwell SC. Late preterm birth: how often is it avoidable?. Am J Obstet Gynecol 2009; 201 (4) 404.e1-404.e4
    CrossrefPubMedGoogle Scholar
  • 13 Lubow JM, How HY, Habli M, Maxwell R, Sibai BM. Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births. Am J Obstet Gynecol 2009; 200 (5) e30-e33
    CrossrefPubMedGoogle Scholar
  • 14 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008; 111 (1) 35-41
    CrossrefPubMedGoogle Scholar
  • 15 Riley LE, Stark AR eds. Guidelines for Perinatal Care. 7th ed. Washington, DC: American Academy of Pediatrics and The American College of Obstetricians and Gynecologists; 2012
    Google Scholar
  • 16 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2, Pt 1): 323-333
    CrossrefPubMedGoogle Scholar
  • 17 Clark SL, Belfort MA, Hankins GD, Meyers JA, Houser FM. Variation in the rates of operative delivery in the United States. Am J Obstet Gynecol 2007; 196 (6) 526.e1-526.e5
    CrossrefPubMedGoogle Scholar
  • 18 Thompson LA, Goodman DC, Chang CH, Stukel TA. Regional variation in rates of low birth weight. Pediatrics 2005; 116 (5) 1114-1121
    CrossrefPubMedGoogle Scholar
  • 19 Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics 2001; 108 (4) 928-933
    CrossrefPubMedGoogle Scholar
  • 20 Berry JG, Toomey SL, Zaslavsky AM , et al. Pediatric readmission prevalence and variability across hospitals. JAMA 2013; 309 (4) 372-380
    CrossrefPubMedGoogle Scholar
  • 21 Wennberg JE. Tracking Medicine: A Researcher's Quest to Understand Health Care. New York: Oxford University Press; 2010
    Google Scholar
  • 22 Goodman DC. Unwarranted variation in pediatric medical care. Pediatr Clin North Am 2009; 56 (4) 745-755
    CrossrefPubMedGoogle Scholar
  • 23 MacDorman MF, Declercq E, Zhang J. Obstetrical intervention and the singleton preterm birth rate in the United States from 1991–2006. Am J Public Health 2010; 100 (11) 2241-2247
    CrossrefPubMedGoogle Scholar
  • 24 Martin JA, Hamilton BE, Sutton PD , et al. Births: Final Data for 2006. Contract No. 7. Hyattsville, MD: National Center for Health Statistics; 2009
    Google Scholar
  • 25 Martin JA, Osterman MJ, Sutton PD. Are Preterm Births on the Decline in the United States? Recent Data from the National Vital Statistics System. NCHS Data Brief. Hyattsville, MD: National Center for Health Statistics; 2010: 1-8
    Google Scholar
  • 26 Zhang J, Troendle J, Reddy UM , et al; Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010; 203 (4) 326.e1-326.e10
    CrossrefPubMedGoogle Scholar
  • 27 Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159 (7) 702-706
    CrossrefPubMedGoogle Scholar
  • 28 Fitzmaurice GM, Laird NM, Ware JH. Applied Longitudinal Analysis. 2nd ed. Hoboken, NJ: Wiley; 2011
    Google Scholar
  • 29 Oshiro BT, Henry E, Wilson J, Branch DW, Varner MW ; Women and Newborn Clinical Integration Program. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol 2009; 113 (4) 804-811
    CrossrefPubMedGoogle Scholar
  • 30 Donovan EF, Lannon C, Bailit J, Rose B, Iams JD, Byczkowski T ; Ohio Perinatal Quality Collaborative Writing Committee. A statewide initiative to reduce inappropriate scheduled births at 36(0/7)-38(6/7) weeks' gestation. Am J Obstet Gynecol 2010; 202 (3) 243.e1-243.e8
    CrossrefPubMedGoogle Scholar
  • 31 Fisch JM, English D, Pedaline S, Brooks K, Simhan HN. Labor induction process improvement: a patient quality-of-care initiative. Obstet Gynecol 2009; 113 (4) 797-803
    CrossrefPubMedGoogle Scholar
  • 32 Glantz JC. Labor induction rate variation in upstate New York: what is the difference?. Birth 2003; 30 (3) 168-174
    CrossrefPubMedGoogle Scholar
  • 33 Aliaga SR, Smith PB, Price WA , et al. Regional variation in late preterm births in North Carolina. Matern Child Health J 2013; 17 (1) 33-41
    CrossrefPubMedGoogle Scholar
  • 34 Aliaga S, Boggess K, Ivester TS, Price WA. Influence of neonatal practice variation on outcomes of late preterm birth. Am J Perinatol 2014; 31 (8) 659-666
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Aliaga S, Price W, McCaffrey M, Ivester T, Boggess K, Tolleson-Rinehart S. Practice variation in late-preterm deliveries: a physician survey. J Perinatol 2013; 33 (5) 347-351
    CrossrefPubMedGoogle Scholar
  • 36 Gyamfi-Bannerman C, Fuchs KM, Young OM, Hoffman MK. Nonspontaneous late preterm birth: etiology and outcomes. Am J Obstet Gynecol 2011; 205 (5) 456.e1-456.e6
    CrossrefPubMedGoogle Scholar
  • 37 Buchanan SL, Crowther CA, Levett KM, Middleton P, Morris J. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev 2010; (3) CD004735
    PubMedGoogle Scholar
  • 38 van der Ham DP, van der Heyden JL, Opmeer BC , et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol 2012; 207 (4) 276.e1-276.e10
    CrossrefPubMedGoogle Scholar