WHY WE WAIT FOR 39 WEEKS GEORGIA HOSPITAL ENGAGEMENT NETWORK (GHEN)
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
GOALS FOR PRESENTATION • WHAT ARE THE RISKS OF DELIVERIES BEFORE 39 WEEKS • NEONATAL OUTCOMES OF EARLY TERM BIRTHS
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
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.
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.
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
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
Baby’s brain • March of dimes MRI image slide
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
Adverse Maternal Outcomes • Chorioamnionitis • Endometritis • Post Partum Anemia • Cesarean Delivery • Pre-eclampsia
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
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