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Obstetric Evidence: What difference does a week make?

What difference does a week make?  Those of us who work in rural Obstetric services know the difficulties of planning for timely intervention and delivery of healthy babies.  The trend in recent years has been to “deliver if in doubt” after 37 weeks.  The thinking being that we have found  neonatal outcomes are pretty much the same wether the babe is 37 weeks or 41.  We are confident to manage a ‘term’ baby rather than run the risk of a bit of raised BP etc.  “”Better out than in” was my first thought when dealing with a complication after 37 weeks – but  this may not be true.

In a large (>400,000 kids), retrospective, Scottish study that looked at Gestation vs. “need for Special Education” (SEN) they found a significant and ‘dose-related’effect on preterm delivery, with significant benefits shown between 37, 38, 39 and 40 weeks.  Basically – if you can keep a baby in the uterus safely until full term, there is a difference in their long-term outcome (as measured by ‘Special Edcuation need”).

The graph below is a snapshot of the data – the scale on the vertical is logarithmic.  It is sobering for all of those of us who have booked inductions or CS for women at 38 weeks for indications such as breech, scheduling demands or even “maternal request”.  Check out the full version of this study at the link below:                                            Any comments?

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000289

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