The Effect of the 39-Week Initiative on Intrauterine Demise

Abstract

INTRODUCTION: Published studies have shown mixed results regarding the risks of intrauterine fetal demise after implementation of guidelines for reduction of nonmedically indicated deliveries before 39 weeks of gestation. Our objective was to describe the variation in rates of intrauterine fetal demise in a high-risk patient population after implementation of guidelines eliminating nonmedically indicated deliveries before 39 weeks of gestation. METHOD: This was a retrospective chart review of patients with intrauterine fetal demise delivering at or beyond 20 weeks of gestation or birth weight 350 g or more when the gestational age was unknown between March 4, 2012, and July 31, 2014, at Hurley Medical Center in Flint, Michigan. RESULTS: A total of 6,561 deliveries were performed during the study period. Group 1: 2,846 deliveries before implementation of the guidelines with 16 cases of intrauterine fetal demise. Group 2: 3,715 deliveries after the guidelines with 29 cases of intrauterine fetal demise. Despite a small sample size, the most concerning observation is that the rate of intrauterine fetal demise between 37 and 39 weeks of gestation increased from 0.35 to 1.35 per 1,000 births after implementation of the guidelines. CONCLUSION: In our institute, the rate of stillbirth has increased since implementation of and strict adherence to guidelines for the elimination of elective induction of labor or cesarean delivery before 39 weeks of gestation were instituted. This is a disturbing trend that needs further evaluation, especially in medical centers caring for a high-risk pool of patients for whom all medical indications are not covered by the lists of approved indications.