2. PROCEDURE: Assessment of Fetal Maturity prior to repeat Cesarean delivery or elective induction of labor.
A. Indication: To prevent fetal pulmonary immaturity and to determine the appropriate time of elective C-section or elective induction of labor.
Confirm the indication by the presence of one or more of the following four criteria:
(1) Clinical Criteria needed to confirm a term gestation are:
(a) Fetal heart tones have been demonstrated for at least 20 completed weeks by nonelectronic fetoscope or at least 30 completed weeks by Doppler ultrasound; and
(b) Appropriate uterine size was established by pelvic examination prior to 16 weeks of gestation. To be determined in writing by each institution.
(2) Ultrasound determinations needed to confirm a term gestation:
(a) Gestational age based on the measurement of crown-rump length obtained between 6 - 11 weeks of gestation; or
(b) Other ultrasound confirmation of gestational age was obtained between 12 - 20 weeks of gestation.
(3) If these criteria are not met, amniotic fluid analysis by a recognized test may provide satisfactory evidence of fetal lung maturity; or
(4) The onset of spontaneous labor.
(References: ACOG Tech. Bulletin #110, ACOG Committee Opinion
#77 and Harvard Medical Institutional Clinical Standard #11.)
