39 Is Fine

On June 22, 2009, 20 participants from 10 Beacon facilities joined Dr. Joseph Derrough for a WebEx call to hear the significance of waiting until 39 weeks to perform an elective delivery. His phrase "39 Is Fine" is our new mantra. Dr. Derrough explained it has been over a decade since the issue of ACOG Practice Bulletin #10 "Induction of Labor" indicating that confirmation of term gestation "gestational age of at least 39 weeks" should occur prior to induction. We know we should do it but do we?  Sadly, a recent study published in the New England Journal of Medicine¹  indicated that many elective inductions are performed prior to 39 weeks. The rate of death and serious disability more than doubles when inductions are performed prior to 39 weeks.

Strategies to change the practice from before to after 39 weeks include: education, comparative data sharing, and testing new practices with one physician.  Try to garner executive level support.  When you obtain agreement about appropriate practice, make sure there are structures in place to support the practice such as making sure there is an estimated age when scheduling an elective induction.  It is always important to identify and nurture your physician champions.

Excellent progress has been made by many facilities by including:

• Using NIHD language in OB units for hospital staff and obstetricians
• Using induction scheduling forms to ensure that estimated gestational age is 39 weeks
• Reviewing past data to determine the number of inductions < 39 weeks
• Improving the care of diabetic patients
• Developing expectations for medical staff credentialing and privileging
• Using the charge RN to schedule elective inductions
• Implementing an induction consent
• Working to decrease shoulder dystocia through the use of drills

Joseph Derrough, MD, is the Physician Chair of the Perinatal Patient Safety Project and Medical Co-Director of Patient Safety for Kaiser Permanente in San Jose. Dr. Derrough serves on the Northern California Regional PPSP Steering Committee for Kaiser Permanente. His patient safety focus includes: human factors; perinatal patient safety; transfer of training; critical events team training; communication at the "sharp end" between and among physicians and hospital staff; and patient safety initiatives in the outpatient setting.

 ¹ Tita ATN, et al. Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. NEJM 360 (2) 2009. 111-120.

Download July 2009 Newsletter