Can i induce labor at 34 weeks

For women suffering from hypertensive disorders of pregnancy after 34 weeks, planned early delivery is associated with less composite maternal morbidity and mortality. There is no clear difference in the composite outcome of infant mortality and severe morbidity; however, this is based on limited data from two trials assessing all hypertensive disorders as one group.

Further studies are needed to look at the different types of hypertensive diseases and the optimal timing of delivery for these conditions. These studies should also include infant and maternal morbidity and mortality outcomes, caesarean section, duration of hospital stay after delivery for mother and duration of hospital stay after delivery for baby.

An individual patient meta-analysis on the data currently available would provide further information on the outcomes of the different types of hypertensive disease encountered in pregnancy.

Hypertensive disorders in pregnancy are significant contributors to maternal and perinatal morbidity and mortality.

These disorders include well-controlled chronic hypertension, gestational hypertension pregnancy-induced hypertension and mild pre-eclampsia.

The definitive treatment for these disorders is planned early delivery and the alternative is to manage the pregnancy expectantly if severe uncontrolled hypertension is not present, with close maternal and fetal monitoring.

There are benefits and risks associated with both, so it is important to establish the safest option. To assess the benefits and risks of a policy of planned early delivery versus a policy of expectant management in pregnant women with hypertensive disorders, at or near term from 34 weeks onwards. We searched Cochrane Pregnancy and Childbirth Trials Register 12 January and reference lists of retrieved studies. Randomised trials of a policy of planned early delivery by induction of labour or by caesarean section compared with a policy of delayed delivery "expectant management" for women with hypertensive disorders from 34 weeks' gestation.

Cluster-randomised trials would have been eligible for inclusion in this review, but we found none. Studies using a quasi-randomised design are not eligible for inclusion in this review.

Similarly, studies using a cross-over design are not eligible for inclusion, because they are not a suitable study design for investigating hypertensive disorders in pregnancy. Induction will be offered if you do not go into labour naturally by 42 weeks, as there will be a higher risk of stillbirth or problems for the baby.

If your waters break more than 24 hours before labour starts, there's an increased risk of infection to you and your baby. If your waters break after 34 weeks, you'll have the choice of induction or expectant management.

Expectant management is when your healthcare professionals monitor your condition and your baby's wellbeing, and your pregnancy can progress naturally as long as it's safe for both of you. Your midwife or doctor should discuss your options with you before you make a decision. They should also let you know about the newborn neonatal special care hospital facilities in your area.

If your baby is born earlier than 37 weeks, they may be vulnerable to problems related to being premature. If your waters break before 34 weeks, you'll only be offered induction if there are other factors that suggest it's the best thing for you and your baby.

You may be offered an induction if you have a condition that means it'll be safer to have your baby sooner, such as diabetes , high blood pressure or intrahepatic cholestasis of pregnancy. If this is the case, your doctor and midwife will explain your options to you so you can decide whether or not to have your labour induced. Before inducing labour, you'll be offered a membrane sweep, also known as a cervical sweep, to bring on labour.

To carry out a membrane sweep, your midwife or doctor sweeps their finger around your cervix during an internal examination. This action should separate the membranes of the amniotic sac surrounding your baby from your cervix.

This separation releases hormones prostaglandins , which may start your labour. Having a membrane sweep does not hurt, but expect some discomfort or slight bleeding afterwards. It doesn't appear to offer any benefit to women carrying more than one baby or with no previous history of preterm labor. If you have signs of preterm labor or think you're leaking amniotic fluid, call your healthcare provider, who will probably have you go to the hospital for further assessment.

You'll be monitored for contractions as your baby's heart rate is monitored, and you'll be examined to see whether your membranes have ruptured. Your urine will be checked for signs of infection, and cervical and vaginal cultures may be taken as well. You may also be given a fetal fibronectin test.

If your water hasn't broken, your provider will do a vaginal exam to assess the state of your cervix. An abdominal ultrasound will often be done as well, to check the amount of amniotic fluid present and confirm the baby's growth, gestational age, and position.

Finally, some providers will do a vaginal ultrasound to double-check the length of your cervix and look for signs of effacement. If all the tests are negative, your membranes haven't ruptured, your cervix hasn't dilated after a few hours of monitoring, your contractions have subsided, and you and your baby appear healthy, you'll most likely be sent home.

For about 3 in 10 women, preterm labor stops on its own. Although each provider may manage the situation a little differently, there are some general guidelines for handling preterm labor.

If you're less than 34 weeks but 24 weeks or more pregnant and found to be in preterm labor, your membranes are intact, your baby's heart rate is reassuring, and you have no signs of a uterine infection or other problems such as severe preeclampsia or signs of a placental abruption , your practitioner will probably attempt to delay your delivery. One way she can do this is by giving you special drugs called tocolytics. Tocolytics can delay delivery for up to 48 hours though they don't always work and are not routinely used.

During that time, if your doctor thinks you're at risk of delivering within 7 days, your baby can be given corticosteroids drugs that cross the placenta to help his lungs and other organs develop faster. This will boost his chance of survival and minimizes some of the risks associated with an early birth.

Corticosteroids are most likely to help your baby when given between 24 and 34 weeks of pregnancy, but they're also given between 23 and 24 weeks. If you're less than 32 weeks pregnant and in preterm labor, and your provider thinks you're at risk of delivering in the next 24 hours, you may also be given magnesium sulfate to reduce the risk of cerebral palsy in your baby.

Cerebral palsy, a nervous system disorder, is associated with early preterm birth. This is done just in case a culture shows you're a carrier, as it takes 48 hours to get results. To take advantage of technological advances in preterm care, a preterm infant is best cared for at a hospital with a neonatal intensive care unit NICU. If you're in a small community hospital where specialized neonatal care is not available for a preterm infant, you'll be transferred to a larger institution at this point, if possible.

Hospitals generally have limits for gestational how premature a baby they're able to care for. If you haven't reached 24 weeks, neither antibiotics for GBS prevention nor corticosteroids are recommended.

Your medical team will counsel you about your baby's prognosis, and you can opt to wait or be induced. If your water breaks before 34 weeks but you're not having contractions, your medical team may decide to induce labor or may opt to wait, hoping to buy the baby more time to mature. It depends on how far along you are and whether there's any sign of infection or other reason that your baby would be better off being delivered.

In any case, unless you've had a recent negative GBS test, you'll be given antibiotics to protect against group B strep. If you're at 34 weeks or more, and your water had broken, you may be induced or delivered by cesarean section. On the other hand, if you're less than 34 weeks pregnant, ACOG recommends waiting to deliver unless there's a clear reason to do otherwise.

The purpose of waiting is to try to give your baby more time to mature. The downside is a higher risk of infection. But at early gestational ages, the benefits of waiting usually outweigh the risks of an immediate induction or c-section. While waiting, you'll receive antibiotics for seven days, to lower the risk of infections and help prolong your pregnancy. You'll also receive a course of corticosteroids to help hasten your baby's lung development.

You and your baby will be monitored carefully during this time. Of course, if you develop symptoms of an infection or there are other signs that your baby is not thriving, you'll be induced or delivered by c-section. Premature babies may need to stay in the NICU until their medical problems resolve, they can feed well without issues, and they've grown big enough. See what happens in the neonatal intensive care unit and how the littlest babies are treated.

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing.

Learn more about our editorial and medical review policies. Reaffirmed Antenatal corticosteroid therapy for fetal maturation. Committee opinion number These steps help stop contractions in about 50 percent of women. If your contractions stop and your cervix doesn't dilate during several hours of observation, you will probably be able to go home. Your obstetrician may decide that postponing the birth through medication is the appropriate course of action.

While there is no established "right" time to start treatment with medication, many doctors recommend beginning once your cervix becomes two to three centimeters dilated.

These drugs don't usually don't postpone labor for long often not more than a couple of days , but sometimes even a short delay can make a lifesaving difference to your baby. For example, your doctor can begin treatment with corticosteroid drugs between 24 and 34 weeks of pregnancy, which are aimed at preventing or lessening complications in preterm newborns.

Corticosteroids speed maturation of fetal organs, reducing infant deaths by about 30 percent and cutting the incidence of the two most serious complications of preterm birth : respiratory distress syndrome and bleeding in the brain.

They are given by injection and are most effective when administered at least 24 hours before delivery. Other medication options include magnesium sulfate which might reduce the risk of cerebral palsy and tocolytics which temporarily slow contractions.

It's important to note, though, that preterm labor medications aren't completely harmless. Putterman says. Your contractions are unlikely to stop on their own if your cervix is dilating. As long as you're between 34 and 37 weeks and the baby already is at least 5 pounds, 8 ounces, the doctor may decide not to delay labor. These babies are very likely to do well even if they're born early. If you have concerns about preterm contractions, speak with your doctor who can recommend strategies to help you safely get to 40 weeks.

By Richard Schwarz, M. Updated July 20,