{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:00:43Z","timestamp":1765807243090,"version":"3.37.3"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,4,8]],"date-time":"2015-04-08T00:00:00Z","timestamp":1428451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000245","name":"Michael Smith Foundation for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000245","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the extent to which implementing a hospital policy to limit planned caesarean deliveries before 39\u00a0weeks of gestation improved neonatal health, maternal health, and healthcare costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>British Columbia Women's Hospital, Vancouver, Canada, in the period 2005\u20132012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with a low\u2010risk planned repeat caesarean delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An interrupted time series design was used to evaluate the policy to limit planned caesarean deliveries before 39\u00a0weeks of gestation, introduced on 1\u00a0April\u00a02008.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Composite adverse neonatal health outcome (respiratory morbidity, 5\u2010minute Apgar score of &lt;7, neonatal intensive care unit admission, mortality), postpartum haemorrhage, obstetrical wound infection, out\u2010of\u2010hour deliveries, length of stay, and healthcare costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2005 and 2008, 60% (1204\/2021) of low\u2010risk planned caesarean deliveries were performed before 39\u00a0weeks of gestation. After the introduction of the policy, the proportion of planned caesareans dropped by 20 percentage points (adjusted risk difference of 20 fewer cases per 100 deliveries; 95%\u00a0CI \u221225.8,\u00a0\u221214.3) to 41% (1033\/2518). The policy had no detectable impact on adverse neonatal outcomes (2.2 excess cases per 100; 95%\u00a0CI \u22120.4,\u00a04.8), maternal complications, or healthcare costs, but increased the risk of out\u2010of\u2010hours delivery from 16.2 to 21.1% (adjusted risk difference 6.3 per 100; 95%\u00a0CI 1.6,\u00a010.9).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found little evidence that a hospital policy to limit planned caesareans before 39\u00a0weeks of gestation reduced adverse neonatal outcomes. Hospital administrators intending to introduce such policies should anticipate, and plan for, modest increases in out\u2010of\u2010hours and emergency\u2010timing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Implementing a policy to limit planned caesareans before 39\u00a0weeks of gestation did not improve newborn health.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13396","type":"journal-article","created":{"date-parts":[[2015,4,8]],"date-time":"2015-04-08T05:53:05Z","timestamp":1428472385000},"page":"1200-1206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Maternal and neonatal outcomes after implementation of a hospital policy to limit low\u2010risk planned caesarean deliveries before 39\u00a0weeks of gestation: an interrupted time\u2010series\u00a0analysis"],"prefix":"10.1111","volume":"122","author":[{"given":"JA","family":"Hutcheon","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EC","family":"Strumpf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health Montr\u00e9al QC Canada"},{"name":"Department Economics McGill University Montr\u00e9al QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Harper","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health Montr\u00e9al QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Giesbrecht","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,4,8]]},"reference":[{"volume-title":"Canadian Perinatal Health Report, 2008 Edition","year":"2008","author":"Public Health Agency of Canada","key":"e_1_2_6_2_1"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.058"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39405.539282.BE"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31819b5c8c"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0803267"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.01.052"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.09.013"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182822193"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000291577.01569.4c"},{"volume-title":"Green\u2010top Guidelines No. 7: Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality","year":"2010","author":"Royal College of Obstetricians and Gynaecologists","key":"e_1_2_6_11_1"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)32763-3"},{"key":"e_1_2_6_13_1","unstructured":"Specifications manual for joint commission national quality measures (v2011A).2011[http:\/\/manual.jointcommission.org\/releases\/TJC2011A\/PerinatalCare.html.] Accessed 09 November 2011."},{"key":"e_1_2_6_14_1","unstructured":"HIghlights from the BORN Ontario LHIN Region Reports for 2009\u20132010.2011[http:\/\/www.bornontario.ca\/_documents\/LHIN%202009-2010%20Reports\/Perinatal%20Health%20Report%202009-2010_Provincial%20Overview%20Presentation.pdf.] Accessed 19 January 2012."},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12278"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)32945-0"},{"key":"e_1_2_6_17_1","unstructured":"British Columbia Ministry of Health.BC Medical Association Guide to Fees November 2013. 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