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Timing of Indicated Late-Preterm and Early-Term Birth

Spong, Catherine Y. MD; Mercer, Brian M. MD; D'Alton, Mary MD; Kilpatrick, Sarah MD, PhD; Blackwell, Sean MD; Saade, George MD

doi: 10.1097/AOG.0b013e3182255999
Current Commentary

The growing public health awareness of prematurity and its complications has prompted careful evaluation of the timing of deliveries by clinicians and hospitals. Preterm birth is associated with significant morbidity and mortality, and affects more than half a million births in the United States each year. In some situations, however, a late-preterm or early-term birth is the optimal outcome for the mother, child, or both owing to conditions that can result in worse outcomes if pregnancy is allowed to continue. These conditions may be categorized as placental, maternal, or fetal, including conditions such as placenta previa, preeclampsia, and multiple gestations. Some risks associated with early delivery are common to all conditions, including prematurity-related morbidities (eg, respiratory distress syndrome and intraventricular hemorrhage) as well as maternal intrapartum morbidities such as failed induction and cesarean delivery. However, when continuation of the pregnancy is associated with more risks such as hemorrhage, uterine rupture, and stillbirth, preterm delivery maybe indicated. In February 2011, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine held a workshop titled “Timing of Indicated Late Preterm and Early Term Births.” The goal of the workshop was to synthesize the available information regarding conditions that may result in medically indicated late-preterm and early-term births to determine the potential risks and benefits of delivery compared with continued pregnancy, determine the optimal gestational age for delivery of affected pregnancies when possible, and inform future research regarding these issues. Based on available data and expert opinion, optimal timing for delivery for specific conditions was determined by consensus.

In certain circumstances, late-preterm or early-term birth is indicated and appropriate to improve outcomes for the mother, child, or both.

From the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the Departments of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, Columbia University, New York, New York, Cedars-Sinai Medical Center, Los Angeles, California, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas; and the University of Texas Medical Branch at Galveston, Galveston, Texas.

For a list of speakers and moderators who participated in the workshop, see the Appendix online at http://links.lww.com/AOG/A249.

Dr. Spong, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.

This document reflects the opinions of the workshop participants, and its contents do not necessarily represent the official views of either the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health, or the Society for Maternal-Fetal Medicine.

Corresponding author: Catherine Y. Spong, MD, Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd, Rm 4B03, MSC 7510, Bethesda, MD 20892 (express mail: Rockville, MD 20852); e-mail spongc@mail.nih.gov.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists.