WHY WE WAIT FOR 39 WEEKS

1. WHY WE WAIT FOR 39 WEEKS GEORGIA HOSPITAL ENGAGEMENT NETWORK (GHEN)

2. 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

3. GOALS FOR PRESENTATION • WHAT ARE THE RISKS OF DELIVERIES BEFORE 39 WEEKS • NEONATAL OUTCOMES OF EARLY TERM BIRTHS

4. 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

5. 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.

6. 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.

7. 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

8. 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

9. Baby’s brain • March of dimes MRI image slide

10. WHY DO BABIES NEED TIME TO MATURE? (39 weeks)

11. 39 WEEKS IS IMPORTANT

12. 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

13. Remember:

14. Adverse Neonatal Outcomes for early deliveries

15. One study comparative risk of early delivery

16. Adverse Maternal Outcomes • Chorioamnionitis • Endometritis • Post Partum Anemia • Cesarean Delivery • Pre-eclampsia

17. 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

18. 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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20. In Summary:

21. References and credit are due:

22. Questions?