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Monday, 31 October 2011
Learning Objective 1: Discuss percentage of live births in Texas in which the mother's labor was induced prior to 39 weeks gestation, for the years 2003 through 2007.
Learning Objective 2: Compare morbidity and mortality rates for neonates born prior to 39 weeks gestation when mother's labor was induced and when mother's labor was not induced.
Infant mortality rate, number of infant deaths per 1000 live births, is a globally accepted indicator of national health. Infant mortality statistics (2005) indicate that the US ranks 30th in the world with an infant mortality rate of 6.9 deaths per 1000 live births. One cause cited throughout the literature is a rise in number of preterm births to a rate of 12.8 per 100 live births in 2006. Births between 34 and 36 weeks gestation account for approximately 75% of all preterm births. Concomitantly, there has been a rise in labor induction, particularly elective labor induction, prior to 39 weeks gestation. According to the American College of Obstetricians and Gynecologists (ACOG, 2009), the overall labor induction rate doubled from 1990 to 2006 to 225 per 1000 live births. ACOG also reported that up to 20% of elective inductions are performed before 39 weeks gestation and that infant harm from elective delivery is greater prior to 39 weeks. The purpose of this retrospective, descriptive study is to analyze merged Texas Birth and Infant Death Certificate data using exploratory, descriptive, and statistical methods. Aims of the study are to quantify and trend rates of labor induction prior to 39 weeks gestation over a five-year period, 2003 – 2007 (most current available), and to examine infant morbidity and mortality related to labor induction, stratifying by gestational age and geographic region. Data from a sample of approximately two million Texas births may provide evidence supporting adoption of clinical policies encouraging obstetric providers to follow guidelines designed to promote patient safety and prevent infant morbidity and mortality. Examining neonatal outcomes related to induction may provide data for nurses and others that educate parents for use in development of prenatal and childbirth education addressing disadvantages and risks of elective induction prior to 39 weeks gestation.