부산대학교 도서관

INTRODUCTION:: The objective of this study was to determine compliance with ACOG recommendations for timing of medically indicated deliveries (MID) and the impact on pregnancy outcomes for high risk pregnancies. METHODS:: A retrospective cohort study was conducted including pregnant women greater than 32 weeks gestation in an academic-affiliated, Maternal Fetal Medicine private practice who were scheduled for a MID. Women were divided between those who delivered prior to their scheduled MID and those who made it to their scheduled time of delivery. Outcomes were compared between groups including maternal, delivery and neonatal outcomes using chi-square and Mann Whitney U test. RESULTS:: Of 204 pregnancies scheduled for a MID, 94.6% (N=193) were compliant with ACOG recommendations. Non-MID occurred for primarily neurologic or malignancy indications. Seventy-seven (38%) delivered prior to their scheduled delivery date. The most frequent indications included labor (31.2%), preeclampsia (26.0%), gestational hypertension (24.7%) and multiple gestation (15.6%). These women had significantly earlier gestational age at delivery (35.4 vs 37.6 weeks; p = 0.0001), higher primary cesarean delivery rate (40.3 % vs. 20.5%; p =0.002), higher rate of NICU admission (53.2% vs 23.6%; p = 0.0001), and greater NICU days (11.4 vs. 1.9; p = 0.0001). No differences in maternal age, parity, race, or BMI were noted between groups. CONCLUSION:: Compliance with ACOG guidelines for MID were achieved in 9 out of 10 high risk pregnancies. Deliveries prior to the scheduled date were due to labor, hypertensive disorders, and multiple gestation, and associated with late preterm birth, higher cesarean rate and NICU stay.