[Irieguy]

[ QUOTE ]


Having not been through the process yet, is there something about 40 weeks that makes the stillbirth rate slightly higher?


[/ QUOTE ]

The "optimal" time for a fetus to be delivered, strictly in terms of balancing fetal risk vs. neonatal complications, is 38 weeks. After that, the stillbirth rate begins to slowly rise. Shortly after 40 weeks, the risk increase becomes dramatic... doubling by 42 weeks and tripling by 43 weeks. This is the reason why nowadays no obstetrician allows their patients to progress to 43 weeks whereas it was common 20 years ago. When I began residency, we routinely delivered patients at 41-42 weeks. Just within the last 5 years or so there has been a trend to induce labor routinely at an earlier date, such that I haven't seen a single 41+ week delivery at my hospital (unless they walk in the door with no prenatal care) in 2 years. I am in the minority to offer routine induction at 39 weeks, but most obstetricians in Las Vegas will not wait much past 40.

The hardest thing to accept is the statistical inevitability. There is some statistical risk for stillbirth after 39 weeks, and no real good reason to wait any longer. But with hundreds of thousands of live deliveries at 40+ weeks each year in the U.S., there will be hundreds of stillbirths at 40+ weeks each year.

I want those to disappear.

There will still be stillbirths at 39, 38, 37 weeks, etc... and there will still be neonatal deaths, where seemingly healthy babies just die in the first few days of life.

But there is a group of babies each year that die in utero at 40+ weeks who would have lived if they were born earlier. I believe that it is our obligation to identify the point at which the risk of induction is clearly outweighed by the risk of continuing pregnancy. I believe this point lies between 38 and 39 weeks. The American College of Obstetrics and Gynecology has a published guideline recommending that routine induction of labor NOT be offered prior to 39 weeks, so we are bound by that recommendatin for the time being. But it will be modified in the near future, I predict.

This topic is deeply troubling for me. The day each of my patients passes 39 weeks of pregnancy I offer induction of labor. If they decline, I lay in my bed at night hoping that I will be able to hear their baby's heartbeat the next time I see them.

Irieguy