623: A collaborative obstetric patient safety initiative improves outcome

not change over the study period (trend P 0.47) but neonatal mortality and morbidity increased from 2.5% to 2.7% (trend P32 weeks gestation, 128,562 (22.3%) were planned births before the due date including 72,564 (12.6%) pre-labor cesarean sections and 55,998 (9.7%) labor inductions. Over the study period there were sustained increases in both pre-labor cesarean and labor induction births. By 2007, 25.3% of all births greater than 32 weeks were both planned and before the due date, with 14.3% pre-labor cesarean births, and 11.0% induction births. Neonatal morbidity and mortality was strongly associated with gestational age with a stepwise reduction in frequency with each additional week of gestation from 69.7% at 33 weeks to 2.0% at 39 weeks following pre-labor cesarean and 49.4% to 2.6% respectively following labor induction. CONCLUSION: Planned birth before the due date is increasing. This was associated with increased morbidity for the neonate and has not been accompanied by a reduction in stillbirths. There is a need to review clinical practice regarding the indication, timing and mode of planned birth with the potential to issue stricter guidelines related to early planned delivery.