RESUMEN
OBJECTIVE: The purpose of this study was to compare labor induction and cesarean delivery rates at term in community vs university hospitals. STUDY DESIGN: A population-based retrospective cohort study of births was performed. Primary outcomes were term gestation at <39 weeks, labor induction, and cesarean delivery. After we adjusted for comorbidities, malpresentation, and previous cesarean delivery, logistic regression assessed the association between hospital type and primary outcomes. RESULTS: Births occur less often in week 37 (n = 24390 [11%] vs 4006 [13%]; adjusted odds ratio [OR], 0.9; 95% confidence interval [CI], 0.8-0.9) and are similar in week 38 in community vs university hospitals. Inductions occur more commonly in community vs university settings at 37 weeks (n = 6440 [27%] vs 757 [19%]; adjusted OR, 1.7; 95% CI, 1.5-1.8) and at 38 weeks (n = 16586 [31%] vs 1530 [21%]; adjusted OR, 1.8; 95% CI, 1.7-1.9). Cesarean rates are no different between hospital types. CONCLUSION: Induction is 70-80% more likely at community vs university hospitals before the optimal gestational age of ≥ 39 weeks, but cesarean delivery rates do not differ at term.
Asunto(s)
Cesárea/estadística & datos numéricos , Hospitales Comunitarios , Hospitales Universitarios , Trabajo de Parto Inducido/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
In the United States, preterm birth rates continue to rise. Many reasons account for this increase, such as demographic changes, infertility treatments, increases in maternal age, more multiple gestations, increasing obesity rates, and maternal comorbid conditions. The American College of Obstetricians and Gynecologists suggests that preterm birth rates have also increased because of a dramatic rise in late preterm births, defined as births between 34 weeks and 36-6/7 weeks of gestation. Late preterm newborns are the fastest growing subset of neonates, accounting for approximately 74% of all preterm births and about 8% of total births. Reviewed is the current literature with regard to the growing problem of late preterm birth to provide the reader with a comprehensive overview of the burden of late preterm birth and to reassess the clinical opinion regarding timing of delivery.