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US Term Stillbirth Rates and the 39-Week Rule: A Cause for Concern?

Nicholson, James M. MD, MSCE; Kellar, Lisa C. MD, MSCE; Ahmad, Shahla MD; Abid, Ayesha MD; Woloski, Jason MD; Hewamudalige, Nadine MD; Henning, George F. MD; Lauring, Julianne R. MD; Ural, Serdar H. MD; Yaklic, Jerome L. MD

Obstetric Anesthesia Digest: March 2017 - Volume 37 - Issue 1 - p 10
doi: 10.1097/01.aoa.0000512000.06517.1d
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(Am J Obstet Gynecol. 2016;214(5):621.e1–621.e9)

The restriction of the use of “elective” delivery before 39 weeks 0 days of gestation, known as “the 39-week rule” or “the Rule,” was mandated in 2010 in the United States. The Rule was applicable to both labor induction and prelabor cesarean delivery, and was developed as higher rates of adverse childbirth outcomes, including infant morbidity and mortality, subsequent to deliveries that occurred before 39 weeks 0 days of gestation had been reported. However, the prospective risk of term stillbirth was known to increase as a function of increasing gestational age, and hence it was speculated that the Rule might increase the overall rate of term stillbirth. This study aimed to determine whether the term stillbirth rate increased during the 7-year period that the 39-week rule was adopted. The number of live births and the number of stillbirths that occurred within each week of gestational age at and further than 37 weeks were obtained from the state health departments for the years 2007 to 2013. The patterns of the timing of term childbirth and term stillbirth were determined as a function of calendar year and gestational age for each state and for the United States overall. The number needed to treat, which represented the number of women who would need to have an early-term delivery without an accepted indication to prevent one term stillbirth, was estimated based on the change in the proportion of deliveries that occurred before the 39th week of gestation in 2013 compared with 2007, and by the estimated change in the incidence of term stillbirth that occurred in 2013 compared with 2007.

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