New AMOR-IPAT publication: impact of the 39-week rule on term stillbirth

Nicholson, James M. (2015). “The 39-week rule and term stillbirth: beneficence, autonomy, and the ethics of the current restrictions on early-term labor induction in the US,” BMC Pregnancy and Childbirth 15(Suppl 1):A9. [Paper presented at the Stillbirth Summit 2014, Medina (Minneapolis), MN, USA, 19-20 June 2014.]

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The cumulative risk of term stillbirth, i.e., the death of a fetus in utero on or after 37 weeks 0 days of gestation, increases with increasing gestational age throughout the term period (37 weeks 0 days – 41 weeks 6 days). Despite this fact, a rule – called the 39-week rule – was established in 2009 that restricts labor induction in the 37th and 38th week of pregnancy (i.e., in the “early-term period”) unless an accepted/approved “indication” is present. The 39-week rule is now a strict clinical guideline that is enforced by professional organizations, governmental agencies and the medical insurance industry[3–5]. The 39-week rule means that a pregnant woman who has an identifiable risk factor for stillbirth but who does not have an accepted “indication” for labor induction has no choice but to wait until at least 39 weeks 0 days before she can be delivered. Unfortunately, the strict application of the 39-week rule has probably led to hundreds of early-term stillborn infants in the US over the past few years.

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