Obstetrical intervention and the singleton preterm birth rate in the United States from 1991-2006.

Abstract:

OBJECTIVES:We examined the relationship between obstetrical intervention and preterm birth in the United States between 1991 and 2006. METHODS:We assessed changes in preterm birth, cesarean delivery, labor induction, and associated risks. Logistic regression modeled the odds of preterm obstetrical intervention after risk adjustment. RESULTS:From 1991 to 2006, the percentage of singleton preterm births increased 13%. The cesarean delivery rate for singleton preterm births increased 47%, and the rate of induced labor doubled. In 2006, 51% of singleton preterm births were spontaneous vaginal deliveries, compared with 69% in 1991. After adjustment for demographic and medical risks, the mother of a preterm infant was 88% (95% confidence interval [CI] = 1.87, 1.90) more likely to have an obstetrical intervention in 2006 than in 1991. Using new birth certificate data from 19 states, we estimated that 42% of singleton preterm infants were delivered via induction or cesarean birth without spontaneous onset of labor. CONCLUSIONS:Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions.

journal_name

Am J Public Health

authors

MacDorman MF,Declercq E,Zhang J

doi

10.2105/AJPH.2009.180570

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

2241-7

issue

11

eissn

0090-0036

issn

1541-0048

pii

AJPH.2009.180570

journal_volume

100

pub_type

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