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ACOG Committee Opinion No. 764 Summary: Medically Indicated Late-Preterm and Early-Term Deliveries

doi: 10.1097/AOG.0000000000003084
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ABSTRACT: The neonatal risks of late-preterm and early-term births are well established, and the potential neonatal complications associated with elective delivery at less than 39 0/7 weeks of gestation are well described. However, there are a number of maternal, fetal, and placental complications in which either a late-preterm or early-term delivery is warranted. The timing of delivery in such cases must balance the maternal and newborn risks of late-preterm and early-term delivery with the risks associated with further continuation of pregnancy. Deferring delivery to the 39th week is not recommended if there is a medical or obstetric indication for earlier delivery. If there is a clear indication for a late-preterm or early-term delivery for either maternal or newborn benefit, then delivery should occur regardless of the results of lung maturity testing. Conversely, if delivery could be delayed safely in the context of an immature lung profile result, then no clear indication for a late-preterm or early-term delivery exists. Also, there remain several conditions for which data to guide delivery timing are not available. Some examples of these conditions include uterine dehiscence or chronic placental abruption. Delivery timing in these circumstances should be individualized and based on the current clinical situation. This Committee Opinion is being revised to include frequent obstetric conditions that would necessitate delivery before 39 weeks of gestation and to apply the most up-to-date evidence supporting delivery recommendations.

This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.

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Number 764 (Replaces Committee Opinion Number 560, April 2013)

For a comprehensive overview of these recommendations, the full-text version of this Committee Opinion is available athttp://dx.doi.org/10.1097/AOG.0000000000003083.

Scan this QR code with your smartphone to view the full-text version of this Committee Opinion.

Committee on Obstetric Practice

Society for Maternal-Fetal Medicine

This Committee Opinion was developed by the Committee on Obstetric Practice in collaboration with Society for Maternal-Fetal Medicine liaison member Cynthia Gyamfi-Bannerman, MD, MS, committee members Angela B. Gantt, MD, MPH and Russell S. Miller, MD, and the Society for Maternal-Fetal Medicine.

Full -text document published online on January 24, 2019

Copyright 2019 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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Official Citation

Medically indicated late-preterm and early-term deliveries. ACOG Committee Opinion No. 764. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e151–55.

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Recommendations

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine make the following recommendations:

  • Deferring delivery to the 39th week is not recommended if there is a medical or obstetric indication for earlier delivery. Table 1 presents recommendations for the timing of delivery for a number of specific conditions.
  • In the case of an anticipated late-preterm delivery, a single course of antenatal betamethasone is recommended within 7 days of delivery in select women who have not received a previous course of antenatal corticosteroids. However, a medically indicated late-preterm delivery should not be delayed for the administration of antenatal corticosteroids.

[Table 1]

[Table 1]

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.