Read Non_Medically_Indicated_Induction_of_Labor_Prior_to_39_Week_Gestation_Jun_11.pdf text version

Posted: Jun 11

National Medical Policy

Subject: Non-Medically Indicated (Elective) Induction of Labor Before 39 Weeks Gestational Age NMP502 Policy Number:

Effective Date: June 2011 _____________________________________________________ This National Medical Policy is subject to the terms in the IMPORTANT NOTICE at the end of this document Policy Statement: Health Net supports the position of the American Congress of Obstetrics and Gynecology and other evidence based sources to consider the practice of elective deliveries performed prior to 39 weeks gestation as causing unwarranted fetal and maternal risk. Unless there are medical indications, Health Net considers it unacceptable practice to allow induction of such early deliveries. According to the ACOG Practice Bulletin Number 107 (August 2009), indications for induction of labor are not absolute but should take into account maternal and fetal conditions, gestational age, cervical status, and other factors. Following are examples of maternal or fetal conditions that may be indications for induction of labor: · · · · · · · · · Abruptio placentae Chorioamnionitis Fetal demise Gestational hypertension Preeclampsia, eclampsia Premature rupture of membranes Post term pregnancy Maternal medical conditions (e.g., diabetes mellitus, renal disease, chronic pulmonary disease, chronic hypertension, antiphospholipid syndrome) Fetal compromise (e.g., severe fetal growth restriction, isoimmunization, oligohydramnios)

Early induction of labor should not be considered for maternal request, availability of effective pain management, provider convenience, or facility scheduling. Labor may be induced for limited logistic reasons, for example, risk of rapid labor, distance from hospital, or psychosocial indications, however, fetal lung maturity must be established before scheduling delivery at less than 39 weeks of gestation. Fetal pulmonary maturity can be inferred from any of the following historic criteria:

1 Non Medically Indicated Induction of Labor Prior to 39 Weeks Gestation Jun 11

Posted: Jun 11

· · · Ultrasound measurement at less than 20 weeks of gestation supports gestational age of 39 weeks or greater. Fetal heart tones have been documented as present for 30 weeks by Doppler ultrasonography. It has been 36 weeks since a positive serum or urine human chorionic gonadotropin pregnancy test result.

The individual patient and clinical situation should be considered in determining when induction of labor is contraindicated. Generally, the contraindications to labor induction are the same as those for spontaneous labor and vaginal delivery. They include, but are not limited to, the following situations: · · · · · · Vasa previa or complete placenta previa Transverse fetal lie Umbilical cord prolapse Previous classical cesarean delivery Active genital herpes infection Previous myomectomy entering the endometrial cavity

Definitions Early term deliveries Late preterm deliveries Elective induction of labor Elective cesarean section Scheduled The delivery of infants born between 37 0/7 through 38 6/7 weeks gestation. The delivery of infants born from 34 0/7 to 36 6/7 weeks gestation. Induction of labor without an accepted medical or obstetrical indication before the spontaneous onset of labor or rupture of membranes. Scheduled primary or repeat cesarean section without an accepted medical or obstetrical indication before the spontaneous onset of labor or rupture of membranes. A planned induction or cesarean section that is scheduled for either elective or non-elective/medically indicated reasons.

Scientific Rationale In 2006, the infant mortality rate was 1.9 for every 1,000 live births for babies born at 40 weeks of pregnancy. The mortality rate increased to 3.9 per 1,000 when a baby was born just a few weeks earlier at 37 weeks of pregnancy and remains statistically significant between 38 4/7 and 38 6/7 weeks of gestation. Over the past 10 years, the rate of premature births in the US has risen from 12 % (480,000) to 27%. Preterm birth is the leading cause of perinatal morbidity and mortality and accounts for 85% of all perinatal morbidity and mortality. Although the vast majority of these deliveries result from spontaneous preterm labor, it has been reported that induction of labor has increased 9.5 percent in 1990 to 22.1 percent in 2004. It is not entirely clear what proportions of these inductions are elective (i.e. without a medical indication); however, the overall rate of induction of labor is rising faster than the rate of pregnancy complications that would lead to a medically indicated induction. Induction of labor appears to double the risk of cesarean section in nulliparous patients well as the risk of instrumental delivery, shoulder dystocia, and hemorrhage. A retrospective 2 Non Medically Indicated Induction of Labor Prior to 39 Weeks Gestation Jun 11

Posted: Jun 11

analysis of 179,701 births showed that the incidence of severe respiratory distress syndrome was 22.5-fold higher for infants born at 37 weeks of gestation and 7.5-fold higher for infants born at 38 weeks of gestation compared with those born at 39 to 41 weeks of gestation. Delivery during the early term period increases the risk of respiratory complications in the newborn, as well as a variety of non-respiratory complications including NICU admissions, sepsis, necrotizing enterocolitis, hypoxicishemic encephalopathy, umbilical artery pH< 7.0, hypoglycemia, apnea/bradycardia, hyperbilirubinema, low Apgar scores at 5 min, risk of brain injury and the potential for long term neurodevelopmental abnormalities. Transient tachypnea of the newborn, persistent pulmonary hypertension, admissions to neonatal intensive care units, prolonged hospital stays beyond 5 days, and other morbidities are significantly increased in those early term elective deliveries. In a study by Wang et al (2004) of 95 near term births, other associated conditions as compared to full term births such as temperature instability (0% vs 15%), hypoglycemia (7% vs 18%), jaundice (38% vs 65%) and poor feeding occurred. There have been increasing efforts to reduce the incidence of elective induction prior to 39 weeks. Multiple national quality organizations have identified elective deliveries prior to 39 weeks as key quality indicators for obstetric hospital care. Groups include the Joint Commission (TJC), National Quality Forum (NQF), and The Leapfrog Group (LFG), identified elective deliveries prior to 39 weeks (induction of labor and cesarean section) as a key quality indicator for obstetric hospital care. In order to support hospitals in eliminating non-medically indicated deliveries before 39 weeks, March of Dimes, California Maternal Quality Care Collaborative (CMQCC), and the California Department of Health, Maternal Child and Adolescent Health Division collaborated on the development of a quality improvement toolkit entitled "Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age; Quality Improvement Toolkit that contains comprehensive literature review about the importance of eliminating elective deliveries before 39 weeks, an implementation guide for hospitals, quality improvement processes and clinical and patient education tools. Examples of best practices are also included. The toolkit is accessible after registration at: http://www.marchofdimes.com/professionals/medicalresources_39weeks.html In summary, research has shown that early elective delivery without medical or obstetrical indication is linked to neonatal morbidities with no benefit to the mother or infant. The practice of elective (non medically indicated) delivery prior to 39 completed weeks of gestation subjects the infant, as well as the mother to an increased risk of suboptimal outcome and should not be performed. Codes Related To This Policy: There are no specific codes related to induction of labor Review History Initial Review: Medical Advisory Council June 2011

Patient Education Websites English and Spanish version available 1. March of Dimes: http://www.marchofdimes.com/?gclid=CLK8_6aGoqkCFQEQbAod02cAtQ

3 Non Medically Indicated Induction of Labor Prior to 39 Weeks Gestation Jun 11

Posted: Jun 11

2. American Congress of Obstetrics and Gynecology: http://www.acog.org/publications/patient_education/bp154.cfm This policy is based on the following evidence-based guideline: 1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 97: Fetal lung maturity. Obstet Gynecol 2008;112:717­26. 2. American College of Obstetricians and Gynecologists. Induction of Labor. ACOG Practice Bulletin 10. Washington, DC: ACOG; 1999 3. Induction of Labor. ACOG Practice Bulletin No. 107. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114: 386­97. References 1. Thirty Nine Weeks CA QI Toolkit: Elimination of Non-Medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age, with Errata. 03/15/2011http://www.cmqcc.org/_39_week_toolkit 2. American Academy of Family Physicians. (2000). Tips from Other Journals: Elective induction doubles cesarean delivery rate, 61, 4.Retrieved June 1, 2011 at: http://www.aafp.org/afp/20000215/tips/39.html. 3. Bates E, Rouse D, Chapman V, Mann ML, Carlo W, Tita A. Fetal lung maturity testing before 39 weeks and neonatal outcomes. American Journal of Obstetrics and Gynecology 2009; 201: S17. 4. Cesarean Delivery on Maternal Request. ACOG Committee Opinion no. 394. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110:1501-4. 5. Clark SL, Frye DR, Meyers JA, Belfort MA, Dilday GA, Kofford S, Englebright J, Perlin JA. Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth. American Journal of Obstetrics and Gynecology 2010; 1: 16. 6. Clark, S., Miller, D., Belfort, M., Dildy, G., Frye, D., & Meyers, J. (2009). Neonatal and maternal outcomes associated with elective delivery. [Electronic Version]. Am J Obstet Gynecol. 2009:156.e1-156.e4. 7. Donovan EF, Besl J, Paulson J, Rose B, Iams J. Infant death among Ohio resident infants born at 32 to 41 weeks of gestation. American Journal of Obstetrics and Gynecology 2010; 58e.1-e.5. 8. Donovan EF, Lannon C, Bailit J. et al. A statewide initiative to reduce inappropriate scheduled births at 36(0/7)-38(6/7) weeks' gestation. American Journal of Obstetrics and Gynecology 2010; 202: 243.e1-8. 9. Farchi S, Di Lallo D, Polo A, et al. Timing of repeat elective caesarean delivery and neonatal respiratory outcomes. Arch Dis Child Fetal Neonatal 2010; 95: F78. 10. Fisch, John M. MD, MMM; English, Dennis MD, MMM; Pedaline, Susan MSN; Brooks, Kerri MSN; Simhan, Hyagriv N. MD, MSCR. Labor Induction Process Improvement: A Patient Quality-of-Care Initiative. Obstetrics & Gynecology: 113(4): 797-803, April 2009 11. Fleischman AR, Oinuma M, Clark SL. Rethinking the definition of "term pregnancy". Obstetrics & Gynecology 2010; 116: 136-139. 12. Glantz JC. Labor induction rate variation in upstate New York: what is the difference?. Birth 2003; 30: 168-74. 13. Glantz, J. (Apr.2005). Elective induction vs. spontaneous labor associations and outcomes. J Reprod Med. 50(4):235-40. 14. Grobman, William A. Elective Induction: When? Ever?. Clinical Obstetrics & Gynecology 2007; 50: 537-546.

4 Non Medically Indicated Induction of Labor Prior to 39 Weeks Gestation Jun 11

Posted: Jun 11

15. Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Elective caesarean section and respiratory morbidity in the term and near-term neonate. Acta Obstet Gynecol Scand 2007;86:389­94 16. Jain L, Dudell GG. Respiratory transition in infants delivered by cesarean section. Semin Perinatol 2006;30:296­304. 17. Kaimal AJ, Little SE, Odibo AO, Stamilio DM, Grobman WA, Long EF, Owens DK, Caughey AB. Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women. American Journal of Obstetrics & Gynecology 2011; 204: 137.e1-e9. 18. King VJ, Pilliod R, Little A. MediCaid Evidence-Based Decisions Project (MED) Elective Inductin of Labor. Oregon Health & Science University 2010; 1-60. 19. MacKay DF, Smith GCS, Dobbie R, Pell JP. Gestational Age at Delivery and Special Educational Need: Retrospective Cohort Study of 407,503 Schoolchildren. PLoS Medicine 2010; 6: 1-10. 20. Macones GA. Elective Delivery before 39 weeks: reason for caution (editorial). American Journal of Obstetrics and Gynecology 2010; 202: 208. 21. Madar J, Richmond S, Hey E. Surfactant-deficient respiratory distress after elective delivery at ,,term.' Acta Paediatr 1999;88:1244­8. 22. Oshiro, Bryan T.; Henry, Erick; Wilson, Janie; Branch, D Ware; Varner, Michael W.; for the Women and Newborn Clinical Integration Program. Decreasing Elective Deliveries Before 39 Weeks of Gestation in an Integrated Health Care System Obstetrics & Gynecology. 113(4):804-811, April 2009. 23. Premature Rupture of Membranes ACOG Practice Bulletin No, 80 Obstet Gynecol. 2007 Apr;109(4):1007-19. 24. Robinson CJ, Villers MS, Johnson DD, Simpson KN. Timing of elective repeat cesarean delivery at term and neonatal outcomes: a cost analysis. American Journal of Obstetrics and Gynecology 2010; 202: 632.e1-6. 25. Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Nannini A, Weiss J, et al. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics 2008;121:e223­32. 26. Tita, A., Landon, M., Spong, C., Lai, Y., Leveno, K., Varner, M, et al. (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. NEJM. 360:2, 111-120. 27. Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics 2004;114:372­6. 28. Yoder BA, Gordon MC, Barth WH Jr. Late-preterm birth: does the changing obstetric paradigm alter the epidemiology of respiratory complications? Obstet Gynecol 2008;111:814­22. 29. Zanardo V, Simbi AK, Franzoi M, Solda G, Salvadori A, Trevisanuto D. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr 2004;93:643­7. Important Notice General Purpose. Health Nets National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and 5 Non Medically Indicated Induction of Labor Prior to 39 Weeks Gestation Jun 11

Posted: Jun 11

are subject to all of the terms, conditions, limitations, and exclusions of the members contract, including medical necessity requirements. Health Net may use the Policies to determine whether under the facts and circumstances of a particular case, the proposed procedure, drug, service or supply is medically necessary. The conclusion that a procedure, drug, service or supply is medically necessary does not constitute coverage. The members contract defines which procedure, drug, service or supply is covered, excluded, limited, or subject to dollar caps. Policy Effective Date and Defined Terms. The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. * In some states, new or revised policies require prior notice or posting on the website before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative. Policy Amendment without Notice. Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, new or revised policies require prior notice or website posting before an amendment is deemed effective. No Medical Advice. The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to members. Members should consult with their treating physician in connection with diagnosis and treatment decisions. No Authorization or Guarantee of Coverage. The Policies do not constitute authorization or guarantee of coverage of particular procedure, drug, service or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations, and dollar caps apply to a particular procedure, drug, service or supply. Policy Limitation: Member's Contract Controls Coverage Determinations. The determination of coverage for a particular procedure, drug, service or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the members contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including preexisting conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Members contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Members contract shall govern. Coverage decisions are the result of the terms and conditions of the Members benefit contract. The Policies do not replace or amend the Members contract. If there is a discrepancy between the Policies and the Members contract, the Members contract shall govern. Policy Limitation: Legal and Regulatory Mandates and Requirements. The determinations of coverage for a particular procedure, drug, service or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. 6 Non Medically Indicated Induction of Labor Prior to 39 Weeks Gestation Jun 11

Posted: Jun 11

Policy Limitations: Medicare and Medicaid. Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service or supply for Medicare or Medicaid members shall not be construed to apply to any other Health Net plans and members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid members by law and regulation.

7 Non Medically Indicated Induction of Labor Prior to 39 Weeks Gestation Jun 11

Information

7 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

537294