I know what you're thinking. What's a geriatrician doing commenting on pregnancy? Well, I'm a family doc at heart. And up until 2003 when I was lured from academia into private practice, I delivered babies. Truth is, I birthed 'em and buried 'em, too. Now that I've established my bona fides, let's recall that back then, any pregnancy beyond 37 weeks was considered term, suggesting a certain homogeneity in outcomes. But as of yesterday, that definition went out the door. In
Committee Opinion #579 published in the November issue of Obstetrics & Gynecology of the American College of Obstetricians and Gynecologists in agreement with the Society for Maternal-Fetal Medicine, "term" pregnancies have been subdivided into the following:
Early term 37 0/7wks thru 38 6/7wks
Full term 39 0/7wks thru 40 6/7wks
Late term 41 0/7wks thru 41 6/7wks
Post term 42 0/7wks and beyond
Of course, this begs the question "why?" Well, let's recall that our
ability to determine date of conception and due date is not always as accurate as one would hope. We're more accurate for those whose menses are regular and present early on in their gestation. However, in those whose menses are irregular and who present late in gestation, our current ultrasound technology is no where near as accurate as we'd hope.
More importantly, a
retrospective population-based cohort study published early online 3 weeks ago in JAMA Pediatrics demonstrated that early term deliveries where associated w/an increase risk of neonatal morbidity, often requiring admission to the neonatal intensive care unit (NICU). Early term infants had greater risk for hypoglycemia (low blood sugar), need for respiratory support including intubation & ventilator management, and intravenous fluids & antibiotics. Of note, more than a third of early term infants were delivered by Cesarean section. Now, whether these early term deliveries were elective or not was not mentioned.
Bottom line: we need to be less cavalier about elective early term deliveries. In other words,
try to stay pregnant until you're at least 39 weeks along, assuming you're both otherwise healthy. If you're not convinced, check out the
work group data published online this past May in JAMA.
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