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WHY WE WAIT FOR 39 WEEKS
GEORGIA HOSPITAL ENGAGEMENT NETWORK
(GHEN)
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C/S RATE STABLE FOR FIRST TIME IN EIGHT YEARS
A new Healthgrades report reveals the national C/S rate held steady at 33% since 2009, leveling off after eight years of steady increase.
ACNM Quick enews 6/21/12
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GOALS FOR PRESENTATION
WHAT ARE THE RISKS OF DELIVERIES BEFORE 39 WEEKS
NEONATAL OUTCOMES OF EARLY TERM BIRTHS
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DEFINITIONS
Early term deliveries are defined as between 37 0/7-38 6/7
Late pre-term deliveries are defined as between 34 0/7-36 6/7
Elective Induction is defined as induction of labor without accepted medical or obstetrical indications before spontaneous onset of labor or rupture of membranes
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DEFINITIONS 2
Elective Cesarean section is a scheduled primary or repeat C/S without accepted medical or obstetrical indications before spontaneous onset of labor or rupture of membranes.
Scheduled means a planned induction or cesarean section that is scheduled for either elective or non-elective medically indicated reasons.
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ACOG CRITERIA FOR GESTATIONAL AGE CONFIRMATION Ultrasound measurements of less than
20 weeks of gestation that supports a gestational age of 39 weeks or greater.
Fetal Heart Tones have been documented as present for 30 weeks by Doppler.
It has been 36 weeks since a positive serum or urine HCG pregnancy test.
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FETAL BRAIN DEVELOPMENT IN THE LAST WEEKS OF PREGNANCY
Recent studies show that late preterm and possibly early term deliveries may increase babies’ risk of brain injuries and neuro-developmental abnormalities.
We know that between 34 and 40 weeks, approximately 50% of cortical volume growth occurs
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Brain development
At 37 weeks the brain weighs only 80% of the weight at 40 weeks and grey matter volume increases at the rate 0f 1.4% per week between 36 and 40 weeks.
There is rapid growth of the cerebellum with approximately 25% of its volume completed after the later preterm period
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Baby’s brain
March of dimes MRI image slide
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WHY DO BABIES NEED TIME TO MATURE? (39 weeks)
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39 WEEKS IS IMPORTANT
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MATERNAL RISK OF DELIVERY BEFORE 39 WEEKS
Your due date may not be exactly right: if your dates are off the baby may be early
Inducing may not work: if the medicine to induce doesn’t work, you might have a C/S
A cesarean section can cause problems for your baby at birth: breathing problems common
Cesarean sections can cause problems during future pregnancies: placental problems
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Remember:
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Adverse Neonatal Outcomes for early deliveries
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One study comparative risk of early delivery
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Adverse Maternal Outcomes
Chorioamnionitis Endometritis Post Partum Anemia Cesarean Delivery Pre-eclampsia
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When Intervention might be necessary:
Abruptions or Placenta previa Chorioamnionitis Oligohydramnios Fetal compromise/IUGR Any Hypertensive Disorder Prolonged Pre-labor Rupture of
Membranes Diabetes uncontrolled/unstable Other Maternal medical conditions
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Early Intervention:
Each hospital, hospital system or perinatal region should set their own internal medical standards for conditions that justify a scheduled delivery prior to 39 weeks.
In the following slide for example three different sets of guidelines are presented
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In Summary:
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References and credit are due:
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Questions?
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