Elective delivery at less than 39 weeks

Purpose of review The prevalence and impact of elective deliveries occurring prior to 39 weeks' gestation has been the focus of several important studies published in recent medical literature. Defined as scheduled deliveries in the absence of medical or obstetrical indications, concern has been raised that many of these procedures are not performed within the parameters of existing clinical guidelines. Recent findings The American College of Obstetricians and Gynecologists (ACOG) recommends that no elective delivery should be performed before the gestational age of 39 weeks; however, studies report rates of 28-35.8% of elective deliveries occurring before 39 weeks and reveal that they also contribute to increased rates of late-preterm births (34 0/7-36 6/7 weeks). These deliveries are associated with increased neonatal morbidity, neonatal intensive care unit admissions, and associated hospital costs compared to deliveries (37 0/7-38 6/7 weeks) occurring at 39-40 weeks. Prevention of early-term elective deliveries has not demonstrated an increased risk for stillbirth. The implementation of hospital quality improvement programs has successfully reduced the occurrence of elective early-term and late-preterm deliveries, as well as associated neonatal morbidity and mortality. Summary Improved compliance with ACOG recommendations and a reduction in elective deliveries before 39 weeks can be achieved through the use of quality improvement processes involving education, tracking of data, and strict enforcement of clinical practice policies.