Monday, September 13, 2010

For a Safe and Healthy Baby, Let labor Begin On It's Own

In a finding with implications for elective cesarean delivery, a large study has found that babies born at term but before 39 weeks may suffer more complications than infants delivered later.

Although the American College of Obstetricians and Gynecologists has recommended that elective delivery not occur before 39 weeks, many infants are delivered earlier without clear indication.

Researchers have presented studies looking at the outcomes of infants considered to be delivered at term, but still slightly early. Data indicate that the extra time can matter to a fetus, even if the difference is only days.

One study involved 12,821 births, all of which were delivered by prelabor elective cesarean at 37 weeks or more. The women, who had an average maternal age of 30 years, were enrolled in 19 centers around the country between 1999 and 2002 as part of the Maternal Fetal Medicine Units registry, sponsored by the National Institutes of Health. Women in the study had all undergone at least 1 prior cesarean and carried singleton pregnancies without malformations. Women were excluded from the study if they had a documented indication for delivery before 39 weeks.

Compared with infants born at 39 weeks, those born at 37 weeks had 2- to 4-fold risk for complications. Infants born at 38 weeks had 1.5 to 2 times the risk for complications. Outcome measures included a list of 7 parameters, including respiratory distress syndrome, neonatal intensive care unit admission, sepsis, or hospitalization for more than 5 days.

Even infants born within 3 days of the 39-week threshold had higher morbidity.