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Fetal lung maturity testing

Published:March 28, 2014DOI:https://doi.org/10.1016/j.ajog.2014.03.049
      To the Editors:
      I agree with the recent article by Towers et al
      • Towers C.V.
      • Freeman R.K.
      • Nageotte M.P.
      • Garite T.J.
      • Lewis D.F.
      • Quilligan E.J.
      The case for amniocentesis for fetal lung maturity in late-preterm and early-term gestations.
      about the use of fetal lung maturity (FLM) testing in select patients and express similar concern about the American Congress of Obstetricians and Gynecologists (ACOG) Committee Opinion that states, “amniocentesis for the determination of fetal lung maturity in the well-dated pregnancy should generally not be used.”
      • Towers C.V.
      • Freeman R.K.
      • Nageotte M.P.
      • Garite T.J.
      • Lewis D.F.
      • Quilligan E.J.
      The case for amniocentesis for fetal lung maturity in late-preterm and early-term gestations.
      American College of Obstetricians and Gynecologists
      Medically indicated late-preterm and early-term deliveries. ACOG Committee opinion no. 560.
      My maternal-fetal medicine practice is located in a vast and rural state with long and harsh winters. Many rural hospitals have discontinued their labor and delivery units, leaving patients with long drives to reach a hospital with obstetric services. Other rural hospitals offer limited obstetric services and frequently refer higher-risk patients to more advanced-level hospitals.
      As an example, a patient was recently referred to our service so she might have the opportunity for a trial of labor after cesarean. This patient resided some 200 miles from our hospital. She had a successful vaginal delivery with her first pregnancy, then a cesarean with her second pregnancy for a fetus in breech position. With her third pregnancy, she had a strong desire for trial of labor after cesarean and was considered an excellent candidate. However, if the patient entered spontaneous labor while at home, she would have undergone a repeat cesarean because her local rural hospital does not allow for patients who desire vaginal birth after cesarean (VBAC). Therefore, at 38 weeks' gestation, we performed amniocentesis for FLM. The results were mature, so we proceeded with induction of labor following ACOG guidelines. The patient had a successful VBAC and both mother and infant returned home safely.
      Without amniocentesis to confirm FLM, we would have had to wait until 39 weeks' gestation to proceed with elective delivery. However, this would have increased the risk of spontaneous labor while at home and reduced the likelihood of a successful VBAC for this patient. In our practice, this is a relatively common dilemma. Some patients live quite an extended distance from a hospital that can provide the level of care they need. In certain clinical scenarios, it can be difficult to determine optimal time of delivery, especially for patients who live quite a distance from the hospital.
      FLM testing is not something to be routinely performed, but there are circumstances where it can be beneficial. Given the recent increased emphasis on avoiding elective delivery <39 weeks, use of FLM testing in select patients can be a valuable tool for reducing overall risks to the patient and fetus and improve the quality and safety of the care we provide.

      References

        • Towers C.V.
        • Freeman R.K.
        • Nageotte M.P.
        • Garite T.J.
        • Lewis D.F.
        • Quilligan E.J.
        The case for amniocentesis for fetal lung maturity in late-preterm and early-term gestations.
        Am J Obstet Gynecol. 2014; 210: 95-96
        • American College of Obstetricians and Gynecologists
        Medically indicated late-preterm and early-term deliveries. ACOG Committee opinion no. 560.
        Obstet Gynecol. 2013; 121: 908-910

      Linked Article

      • The case for amniocentesis for fetal lung maturity in late-preterm and early-term gestations
        American Journal of Obstetrics & GynecologyVol. 210Issue 2
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          The recent American College of Obstetricians and Gynecologists Committee Opinion no. 560 and the Society of Maternal-Fetal Medicine article argue for the abandonment of fetal lung maturity (FLM) testing.1,2 We concur with the conclusion that the timing of delivery in certain complicated obstetric conditions can be complex and that a risk management decision must be made. This process involves considering the risks to the neonate from premature birth vs maternal and fetal risks that are associated with pregnancy continuation.
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