national efforts to reduce this practice, the rate of early elective Methods deliveries fell from 17% in 2010 to 11.2% in 2012. Great All singleton live births occurring in Mississippi were asvariation remains in the rate of early elective deliveries among sessed by completed weeks of gestation using 2001 to 2011 birth the states, ranging from under 5% to over 25%.11 According to certificate data. Non-medically indicated cesarean deliveries the consensus reached through partnerships among experts and and inductions were identified using an algorithm that removed the March of Dimes, acceptable early elective delivery rates indicated deliveries such as preeclampsia and fetal distress, are considered to be less than 5%, rather than 0%, as there will among others. The early elective delivery rate was calculated continue to be acceptable reasons for delivery that do not fit into as the number of deliveries between 37 weeks and 38 weeks, 6 measured indications and errors in measurement can persist.2 days with no documented labor or medical indication for early There is limited published data about early elective delivdelivery. Trends in all deliveries were also assessed. Tests for eries in Mississippi. Of the five Mississippi hospitals reporting statistical significance at an alpha level of .05 were calculated. to Leapfrog in 2012, rates of elective deliveries ranged from a Death certificate records from 2007 to 2011 were linked low of 2.2% to a high of 50%â&#x20AC;&#x201D;well above the national target with birth certificate records during the same time frame for inrate of 5% or less.11 As early elective deliveries are a source fants up to 28 days old in order to discern mortality rates shortly of preventable morbidity and mortality and since Mississippi after birth. Death rates for early, non-medically indicated delivcontinues to have the highest infant mortality rate in the United eries were then compared to the death rates for infants delivered States, understanding this practice is important for improving at 39 weeks of gestation. Confidence intervals were calculated at birth outcomes in the state.12 In this study, we describe the statethe 95% level to determine statistically significant differences. wide trends in early elective deliveries in Mississippi and explore the Trends impact of practice infant mortality. Results Figure_1: forthis Livehealth Birthscare by Week of on Gestation in Mississippi, 2001-2011 Delivery Rate Trends Fig 1. Trends for Live Births by Week of Gestation in Mississippi, 2001-2011 In Mississippi, all deliveries between 39-41 weeks gestation declined <39 Weeks 39-41 Weeks significantly between 2001 to 2011 from 65% 60.6% to 49.6% (p<.01) (Figure 1). Dur60.6% ing the same time frame, deliveries be57.9% fore 39 weeks of gestation rose signifi55.4% 55% 54.1% cantly (p<.01). Half of all infants born 52.0% 50.4% 50.8% 49.6% 50.2% during this time frame were delivered 50.1% 50.1% 49.5% before 39 weeks of completed gestation. 49.3% 49.6% 49.5% 50.1% 48.6% 47.2% The increase in deliveries before 45% 45.1% 39 weeks is primarily attributable to a 43.6% 41.0% rise in early term births during 37 and 38.3% 38 weeks gestation (Figure 2). While 35% preterm deliveries at 36 weeks gesta2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 tion or less remained relatively stable, deliveries during the early term period Figure 2: Trends for Live Births by Week of Gestation in Mississippi, 2001-2011 Fig 2. Trends for Live Births by Week of Gestation in Mississippi, 2001-2011 of 37 and 38 weeks increased significantly (p<.01) from 26.7% to 36.5%. <37 Weeks 37-38 Weeks 39-41 Weeks Early elective delivery trends in 65% 60.6% Mississippi from 2001 to 2011 are shown 57.9% 55.4% in Figure 3. The rate rose significantly 54.1% 55% 52.0% 50.8% 50.1% 49.3% 49.6% 50.2% 50.1% (p<.01) from 8.5% in 2001 to a peak of 17.8% in 2008. The rates began to de45% cline from 2009 through 2011. Yet, 1 36.4% 36.0% 36.5% 36.9% 35.5% 33.3% 34.3% 35% 32.0% out of every 6 infants born in 2011 were 30.5% 28.3% 26.7% delivered before 39 weeks of completed 25% gestation without any medical indication. 15% 5%
11.6%
2001
12.7%
2002
13.1% 13.1%
2003
2004
13.9%
2005
14.3%
2006
14.0%
2007
13.5%
2008
13.8%
2009
13.5%
2010
13.1%
2011
Death Rate Analyses Infant mortality is far less common for those delivered during the early term period than those delivered before
August 2014 JOURNAL MSMA 253