Inr J Gynecul Obster, 1991, 35: 219 219

International Federation of Gynecology and Obstetrics

Assessment of fetal maturity prior to repeat cesarean delivery

or elective induction of labor

ACOG Committee Opinion: Committee on Obstetrics: Maternal and Fetal Medicine

Number 77 - January 1990 (replaces #72, August 1989)

The assessment of fetal maturity is an important
consideration in determining the timing of a
repeat cesarean delivery or elective induction of
labor. In a gestation in which 39 weeks have
elapsed since the last menstrual period in a
patient with normal menstrual cycles and no
immediate antecedent use of oral contraceptives,
fetal maturity can be assumed if one of the fol-
lowing clinical criteria for estimating gestational
age are supported by at least one of the follow-
ing laboratory determinations:
Clinical Criteria
1. Fetal heart tones have been documented for
up to 20 weeks by nonelectronic fetoscope or
for up to 30 weeks by Doppler.
2. Uterine size has been established by pelvic
examination prior to 16 weeks of gestation.
tive serum or urine human chorionic gona-
dotropin (hCG) pregnancy test, or
2. Ultrasound
a. Measurement based on the crown-rump
length obtained between 6-12 weeks of
gestation, or
b. Other ultrasound confirmation of gesta-
tional age obtained before 24 weeks of
gestation (1)
If these criteria are not met, amniotic fluid
analysis for lecithin/sphingomyelin (L/S) ratio
or phosphatidylglycerol may provide satisfac-
tory evidence of fetal lung maturity. Another
option is to await the onset of spontaneous
labor.
REFERENCE

Laboratory Determinations AmericanCollegeof Obstetriciansand Gynecologists.

Ultrasoundin pregnancy.ACOGTechnical
1. Thirty-six weeks have elapsed since a posi- Bulletin116. Washington,DC: ACOG,1988

Copyright Q January 1!3!30

This document reflects emerging clinical and scientific advances as of the date issued and is
subject to change. The information should not be construed as dictating an exclusive course
i of treatment or procedure to be followed.
The American College of Obstetricians and Gynecologists
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