Scheduled Deliveries: Avoiding Iatrogenic Prematurity

Abstract

The balance of maternal, fetal, and neonatal risks of continued pregnancy versus iatrogenic delivery must be based on best evidence. Although avoiding elective deliveries prior to 39 weeks is well established to improve neonatal outcomes, several "soft" conditions are commonly considered to require delivery prior to 39 weeks. Review of existing literature suggests that with some of these conditions, delivery can be safely delayed until later in pregnancy or even allowed to proceed without intervention. Late preterm and early term deliveries contribute substantially to neonatal morbidity and health care costs and should be considered only if the risks of continuing the pregnancy exceed the neonatal risks related to early birth. In this article, we review some the common clinical scenarios that may result in scheduled early term or late preterm births, with a focus on practice strategies for improving maternal and neonatal outcomes.

Re: Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: A prospective cohort study. Lancet 2015; 386:2089‐97. Sovio U, White IR, Dacey A, Pasupathy D, Smith GC

“…by offering routine third trimester scans to otherwise healthy women, would we increase the number of unnecessary interventions? In clinical settings, additional information on fetal growth in the third trimester would certainly influence the clinicians' decision on methods of birth, which may result in significant perinatal complications associated with iatrogenic preterm births (such as: interventricular haemorrhage, cerebral palsy or neonatal death). The balance between the morbidity associated with intrauterine growth restriction and complications secondary to preterm delivery, determines the timing and mode of delivery.…”

Early Neonatal Outcomes in Patients with Late Preterm Birth

“…Recently, two papers concluded that the burden of prematurity can be decreased if elective late preterm delivery is eliminated, and birth should be considered only if the risk of continuation the pregnancy exceeds the neonatal risks related to early birth (7,28) .…”

Employment During Pregnancy and Obstetric Intervention Without Medical Reason: Labor Induction and Cesarean Delivery

“…Childbirth that occurs as a result of medical intervention rather than spontaneous labor (i.e., nonphysiologic birth), is an increasing focus of clinical and policy dialogue (Chescheir & Menard, 2012; Sakala, 2006). Obstetric procedures can be life-saving when medically necessary (Wong & Grobman, 2011), and balancing the risks and benefits of intervention to hasten childbirth, either through induction of labor or cesarean section is challenging for both women and clinicians (AAP Committee on Fetus and Newborn & ACOG Committee on Obstetric Practice, 2012; ACOG Committee on Practice Bulletins - Obstetrics, 2009; American College of Obstetricians and Gynecologists, 2007, 2014).…”