Strategies to Avoid 5 Highly Overused Treatments

Leigh Page

July 16, 2013

In This Article

Early Scheduled Births

Early-term nonmedically indicated elective delivery has been a chronic problem in obstetrics, said Joshua Copel, MD, professor of obstetrics, gynecology, and reproductive science at Yale University School of Medicine in New Haven, Connecticut.

Unless there are complications, deliveries should not be made before 39 weeks of conception, but many deliveries are induced in the 37th or 38th week, he said. This is not just for the convenience of the physician, he added. In hot summer weather, pregnant women, who are sensitive to heat, sometimes ask for an early delivery.

"I am in favor of anything we can do to get the word out so that people understand the advantages of waiting to at least 39 weeks for elective deliveries," he said. Earlier delivery can lead to complications at birth that could permanently harm the baby or require admission to expensive neonatal intensive care units.

However, Dr. Copel emphasized that early delivery may be necessary for the mother or infant's health, and he cautioned against drawing a firm line at 39 weeks. He reported that some hospitals have been pressuring physicians not to deliver at all before 39 weeks.

Recommendations: Standardize how gestational age is calculated, make the early elective delivery indications and exclusion list as comprehensive as possible to improve clinical practice, educate patients and physicians about the risks of nonmedically indicated early elective deliveries.

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