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CO #765, Avoidance of nonmedically indicated early-term deliveries and associated neonatal morbidities

There are medical indications in pregnancy for which there is evidence or expert opinion to support delivery versus expectant management in the early-term period. However, the risk of adverse outcomes is greater for neonates delivered in the early-term period compared with neonates delivered at 39 weeks of gestation. In addition to immediate adverse perinatal outcomes, multiple studies have shown increased rates of adverse long-term infant outcomes associated with late-preterm and early-term delivery compared with full-term delivery. A recent systematic review found that late-preterm and early-term children have lower performance scores across a range of cognitive and educational measures compared with their full-term peers. Further research is needed to better understand if these differences are primarily based on gestational age at delivery versus medical indications for early delivery. Documentation of fetal pulmonary maturity alone does not necessarily indicate that other fetal physiologic processes are adequately developed. For this reason, amniocentesis for fetal lung maturity is not recommended to guide timing of delivery, even in suboptimally dated pregnancies. Avoidance of nonmedically indicated delivery before 39 0/7 weeks of gestation is distinct from, and should not result in, an increase in expectant management of patients with medical indications for delivery before 39 0/7 weeks of gestation. Management decisions, therefore, should balance the risks of pregnancy prolongation with the neonatal and infant risks associated with early-term delivery. Although there are specific indications for delivery before 39 weeks of gestation, a nonmedically indicated early-term delivery should be avoided. This document is being revised to reflect updated data on nonmedically indicated early-term deliveries.