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    Proposed Perinatal Standard Addressing Non-Medically Indicated Deliveries
    Prior to 39 Weeks Gestation  - 
    Opportunity for Public Comment
    As part of a broad public health effort to improve birth outcomes in Maryland, the Maryland Department of Health (the Department) has developed a standard for Maryland birthing hospitals to address the delivery of infants prior to 39 weeks gestation without a medical indication.  This proposed standard is presented for public comment through June 15, 2012.  The final standard will become effective on July 1, 2012 as part of the Maryland Perinatal System Standards
    The Maryland Perinatal System Standards were originally developed in the mid 1990s as a set of voluntary standards for Maryland hospitals providing obstetrical and neonatal services.  The Standards have since been incorporated into regulation by the Maryland Institute of Emergency Medical Services Systems (MIEMSS), as well as the Maryland Health Care Commission.  The Standards were most recently updated in 2008 in order to be consistent with the latest edition of the Guidelines for Perinatal Care, issued jointly by the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn and the American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice.
    Deliveries prior to 39 weeks without medical indication contribute significantly to neonatal morbidity, infant mortality, and hospital costs.  Elimination of these early elective deliveries is supported by advocacy groups, professional organizations, federal agencies, and national accrediting organizations. Among these are the March of Dimes, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the U.S. Department of Health and Human Services, the Center for Medicare and Medicaid Innovation, and the Joint Commission.
    The Department has strongly supported statewide efforts through the Maryland Patient Safety Center and its Perinatal Learning Network with the goal of eliminating non-medically indicated deliveries prior to 39 weeks gestation.  Through this initiative, the majority of Maryland birthing hospitals have already committed to eliminating these unnecessary and medically risky early deliveries through the adoption of strong hospital policies and compliance monitoring plans.
    Given the success of statewide efforts and the nationwide momentum, the Department plans to incorporate a new standard addressing non-medically indicated deliveries prior to 39 weeks gestation into the Maryland Perinatal System Standards.  The incorporation of the new standard will allow the Department to continue to monitor non-medically indicated deliveries prior to 39 weeks gestation through hospital site visits by the Morbidity, Mortality and Quality Review Committee and MIEMSS. 
    The draft standard is posted below, in a format consistent with the full Perinatal System Standards.  Please submit comments to Dr. Lee Woods, Medical Director, Center for Maternal and Child Health, at Lee.Woods@maryland.gov by June 15, 2012.
    Perinatal Standard Addressing Non-Medically Indicated Deliveries Prior to 39 Weeks Gestation:
    Level of Perinatal Care
    13.7   The hospital shall have a policy to eliminate deliveries by induction of labor or by cesarean section prior to 39 weeks gestation without a medical indication.  The hospital shall have a systematic internal review process to evaluate any occurrences and a plan for corrective action.
             Essential requirement for level of perinatal care