Trends in planned early birth : a population-based study

Objective: The purpose of this study was to describe trends and outcomes of planned births. Study Design: Data from linked birth and hospital records for 779,521 singleton births at <33 weeks' gestation from 2001-2009 were used to determine trends in planned births (prelabor cesarean section and labor inductions). Adverse outcomes were composite indicators of maternal and neonatal morbidity/death. Results: From 2001-2009, there were increases in labor inductions and prelabor cesarean deliveries at <40 weeks' gestation, but no decrease in the stillbirth rate (trend P =.34). By 2009, 14.9% of live births at <33 weeks' gestation were prelabor cesarean deliveries before the due date; 11.4% were inductions. As planned births increased, maternal risks shifted, which included a decline in inductions with maternal hypertension from 31.9-23.9%. Earlier birth was contemporaneous with increases (trend P <.001) in neonatal and maternal morbidity rates from 3.0-3.2% and 1.1-1.5%, respectively. Conclusion: Planned birth before the due date is increasing without a contemporaneous reduction of stillbirths.