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Nonmedically Indicated Early-Term Deliveries American College of Obstetricians and Gynecologists Committee Opinion 561

The rate of nonmedically indicated early-term deliveries continues to increase in the United States. Neonatal morbidity and mortality rates are greater during the early-term period delivery. Management decisions should balance the risks of pregnancy prolongation with the neonatal and infant risks associated with early-term delivery. 

  • The rate of nonmedically indicated early-term deliveries continues to increase in the United States. Neonatal morbidity and mortality rates are greater during the early-term period delivery. Management decisions should balance the risks of pregnancy prolongation with the neonatal and infant risks associated with early-term delivery. Medical indications in pregnancy for which there is evidence or expert opinion to support expedient delivery in the early-term period versus expectant management. (Box1)
  • Suspected macrosomia, well-controlled gestational diabetes, and documented pulmonary maturity with no other indication are all examples of conditions that are not indications for an early-term delivery.
  • Neonates delivered during the early-term period by cesarean delivery, in the absence of indications for delivery, were associated with a higher risk of a composite outcome of neonatal respiratory and nonrespiratory morbidities compared with neonates delivered at 39 weeks of gestation. 
  • Scheduled cesarean delivery even a few days before 39 weeks of gestation should be avoided.
  • NICU admission rates were increased 3 fold and 2 fold when infants were delivered without medical indications at 37 weeks and 38 weeks respectively.
  • Although, the rates of meconium aspiration were lower among neonates born at 37 and 38 weeks gestation, the rates of hyaline membrane disease were higher. When these two etiologies of pulmonary disease were examined as the combined metric of need for neonatal ventilation, the rates of disease were increased.
  • The risk of a 5-minute Apgar score less than 7 decreased from 1.01% at 37 weeks of gestation to 0.69% at 38 weeks of gestation and 0.61% at 39 weeks of gestation. (Box 2)
  • Compared to expectant management neonatal mortality rates are increased.


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