Why would a healthy 31-year-old white woman, gravida (number of pregnancies) three, para (number of viable births) two, need to deliver at 38 weeks instead of going to term at 40 weeks?

Delivery at 38 Weeks for a Healthy G3P2 Woman

For a healthy 31-year-old G3P2 at 38 weeks with no complications, there is no medical indication for delivery before 39-40 weeks, and doing so would increase neonatal morbidity without maternal or fetal benefit. 1, 2

Standard Delivery Timing for Uncomplicated Pregnancy

• Full-term delivery occurs at 39-40 weeks gestation, and elective delivery before 39 weeks is not recommended by the American College of Obstetricians and Gynecologists for uncomplicated pregnancies 1, 2

• A policy of labor induction at 39-41 weeks compared to expectant management reduces perinatal death (RR 0.31), stillbirth (RR 0.30), and cesarean section rates (RR 0.90) without increasing operative vaginal births 2

• Delivering at 38 weeks versus 39-40 weeks in healthy pregnancies increases risks of neonatal respiratory distress syndrome, NICU admission, and other neonatal complications without providing maternal benefit 1

Medical Indications That Would Justify 38-Week Delivery

The following conditions would warrant delivery at 38 weeks, but you've specified this patient is healthy:

Fetal Growth Restriction

• FGR with estimated fetal weight between 3rd-10th percentile and normal umbilical artery Doppler warrants delivery at 38-39 weeks 3, 1, 4
• Severe FGR with estimated fetal weight <3rd percentile requires delivery at 37 weeks regardless of Doppler findings 3, 1

Gestational Diabetes

• Diet-controlled gestational diabetes indicates delivery at 38 weeks 1
• Medication-dependent gestational diabetes warrants delivery by 39 weeks 1

Intrahepatic Cholestasis of Pregnancy

• ICP with bile acids <100 μmol/L justifies delivery between 36-39 weeks 5, 1
• ICP with bile acids ≥100 μmol/L requires delivery at 35-36 weeks due to sudden fetal demise risk 5, 1

Pre-existing Liver Disease

• Most pre-existing liver disorders can be managed with planned delivery in early term (38-39 weeks) 5

Placenta Accreta Spectrum Disorder

• Stable patients with placenta accreta spectrum require scheduled delivery at 34-36 weeks, or up to 38 weeks in select cases 5, 1

Critical Pitfall to Avoid

• Nearly half of women incorrectly believe it is safe to deliver before 37 weeks, and most believe full term occurs before 39 weeks 6

• This misunderstanding can lead to patient-requested early delivery without medical indication, which increases neonatal morbidity 6

• Accurate dating with first-trimester ultrasound before 21 weeks is critical to avoid iatrogenic early-term delivery 1

The Bottom Line

Without a specific maternal or fetal complication (FGR, gestational diabetes, cholestasis, liver disease, placenta accreta, or other high-risk condition), delivery at 38 weeks offers no benefit and increases neonatal risk. 1, 2 The patient should be counseled that waiting until 39-40 weeks or spontaneous labor optimizes both maternal and neonatal outcomes. 2