International Federation of Gynecology and Obstetrics
Fetal maturity delivery
assessment prior to elective repeat cesarean
ACOG Committee Opinion: Committee on Obstetrics: Maternal and Fetal Medicine Number 98 -
September 199 1
(Replaces No. 77, January 1990) The assessment of fetal maturity is important in determining the timing of a repeat cesarean delivery. For patients being considered for elective repeat cesarean deliveries, if one of the following criteria is met, fetal maturity may be assumed and amniocentesis need not be performed: 1. Fetal heart tones have been documented for 20 weeks by nonelectronic fetoscope or for 30 weeks by Doppler. 2. It has been 36 weeks since a positive serum or urine human chorionic gonadotropin pregnancy test was performed by a reliable laboratory. 3. An ultrasound measurement of the crown-rump length, obtained at 6-11 weeks, supports a gestational age of 2 39 weeks. 4. An ultrasound, obtained at 12-20 weeks, confirms the gestational age of 2 39 weeks determined by clinical history and physical examination.
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These criteria are not intended to preclude the use of menstrual dating. If any one of the above criteria confirms gestational age assessment on the basis of menstrual dates in a patient with normal menstrual cycles and no immediately antecedent use of oral contraceptives, it is appropriate to schedule delivery at 2 39 weeks by the menstrual dates. Ultrasound may be considered confirmatory of menstrual dates if there is gestational age agreement within 1 week by crown-rump measurement obtained at 6-11 weeks or within 10 days by the average of multiple measurements obtained at 12-20 weeks (1). Awaiting the onset of spontaneous labor is another option.
REFERENCE 1. American College of Obstetricians and Gynecologists. Ultrasound in pregnancy. ACOG Technical Bulletin 116. Washington, DC: ACOG, 1988
1991
This document reflects emergrng clinical and screntific advances as of the date Issued and is subject to change. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. The American College of Obstetricians and Gynecologrsts 409 12th Street, SW ??Washington, DC 20024-2188 Int J Gynecol Obstet 38