Indicated Late-Preterm and Early-Term Deliveries

Preterm birth is associated with significant short-term and long-term morbidity with implications beyond the neonatal period. However, in certain situations, indicated preterm birth or early term birth results in the best outcome for mother, baby or both. The pathophysiology underlying conditions that are indications for an indicated birth before 39 weeks can be loosely grouped into four areas: placenta/ uterus, fetal, maternal, and obstetric conditions. Placental conditions include those that increase the risk of bleeding such as placenta previa, accreta, increta, percreta and those that increase the risk of uterine rupture such as a prior classical cesarean delivery and myomectomy involving the myometrium. Women with diabetes should be counseled on the importance of glycemic control prior to conception. The timing of these deliveries should be individualized to optimize the outcome based on evidence and expert opinion, as well as the specific clinical situation.