ACOG medically indicated late preterm early term deliveries timing table committee opinion 2019 reaffirmed

pregnancy delivery timing medical complications

https://www.acog.org/clinical/clinical-guidance/committee-op…

site:obgproject.com ACOG when to deliver medically complicated pregnancies timing delivery diabetes hypertension cholestasis

site:acog.org medically indicated delivery table chronic hypertension diabetes preeclampsia cholestasis 34 37 39 weeks

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mkdir -p "/tmp/workspace/delivery-timing-pdf/src" "/tmp/workspace/delivery-timing-pdf/output" && python - <<'PY' from pathlib import Path from reportlab.lib import colors from reportlab.lib.enums import TA_CENTER from reportlab.lib.pagesizes import A4, landscape from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, PageBreak, KeepTogether from reportlab.pdfbase.ttfonts import TTFont from reportlab.pdfbase import pdfmetrics out = Path('/tmp/workspace/delivery-timing-pdf/output/delivery_timing_in_medical_disorders_of_pregnancy.pdf') styles = getSampleStyleSheet() styles.add(ParagraphStyle(name='DocTitle', parent=styles['Title'], fontName='Helvetica-Bold', fontSize=18, leading=22, alignment=TA_CENTER, textColor=colors.HexColor('#17365D'), spaceAfter=8)) styles.add(ParagraphStyle(name='SubTitle', parent=styles['Normal'], fontName='Helvetica', fontSize=9.5, leading=12, alignment=TA_CENTER, textColor=colors.HexColor('#555555'), spaceAfter=12)) styles.add(ParagraphStyle(name='H', parent=styles['Heading2'], fontName='Helvetica-Bold', fontSize=12, leading=14, textColor=colors.HexColor('#17365D'), spaceBefore=7, spaceAfter=5)) styles.add(ParagraphStyle(name='Cell', parent=styles['BodyText'], fontName='Helvetica', fontSize=7.5, leading=9.2, spaceAfter=0)) styles.add(ParagraphStyle(name='CellBold', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=7.5, leading=9.2, spaceAfter=0)) styles.add(ParagraphStyle(name='Note', parent=styles['BodyText'], fontName='Helvetica', fontSize=8.1, leading=10.2, spaceAfter=4)) styles.add(ParagraphStyle(name='Small', parent=styles['BodyText'], fontName='Helvetica', fontSize=7.4, leading=9.1, textColor=colors.HexColor('#444444'))) P=lambda t, s='Cell': Paragraph(t, styles[s]) def table(data, widths=(4.2*cm, 7.5*cm, 12.0*cm)): rows=[] for r, row in enumerate(data): rows.append([P(x, 'CellBold' if r==0 else 'Cell') for x in row]) t=Table(rows, colWidths=widths, repeatRows=1, hAlign='LEFT') t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0),colors.HexColor('#1F4E78')), ('TEXTCOLOR',(0,0),(-1,0),colors.white), ('VALIGN',(0,0),(-1,-1),'TOP'), ('GRID',(0,0),(-1,-1),0.25,colors.HexColor('#AFC5D8')), ('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,colors.HexColor('#EEF5FA')]), ('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4), ])) return t maternal=[ ['Disease / condition','Clinical status','Suggested timing of delivery'], ['Chronic hypertension','Uncomplicated, no medication','38+0 to 39+6 weeks'], ['Chronic hypertension','Controlled on medication','37+0 to 39+6 weeks'], ['Chronic hypertension','Difficult to control','36+0 to 37+6 weeks'], ['Gestational hypertension','No severe-range blood pressure','37+0 weeks, or at diagnosis if later'], ['Gestational hypertension','Severe-range blood pressure','34+0 weeks, or at diagnosis if later'], ['Preeclampsia','Without severe features','37+0 weeks, or at diagnosis if later'], ['Preeclampsia','With severe features, stable mother and fetus','34+0 weeks, or at diagnosis if later'], ['Preeclampsia / HELLP / eclampsia','Unstable disease, HELLP, eclampsia, uncontrolled severe BP, pulmonary edema, progressive renal/hepatic dysfunction, abruption, or nonreassuring fetus','Expedite delivery after maternal stabilization, regardless of gestational age'], ['Chronic hypertension with superimposed preeclampsia','Without severe features','Usually 37+0 weeks'], ['Chronic hypertension with superimposed preeclampsia','With severe features','34+0 weeks if stable; earlier if unstable'], ['GDM','Diet controlled, good control (A1GDM)','39+0 to 40+6 weeks'], ['GDM','Medication controlled, good control (A2GDM)','39+0 to 39+6 weeks'], ['GDM','Poor control','Individualize; commonly 37+0 to 38+6 weeks depending on severity and testing'], ['Pregestational diabetes','Well controlled, no vascular disease','39+0 to 39+6 weeks'], ['Pregestational diabetes','Vasculopathy, nephropathy, poor control, prior stillbirth, or other complications','36+0 to 38+6 weeks, individualized'], ] liver=[ ['Disease / condition','Clinical status','Suggested timing of delivery'], ['Intrahepatic cholestasis of pregnancy','Total bile acids <100 micromol/L','36+0 to 39+0 weeks; lower levels can generally be managed nearer 39 weeks'], ['Intrahepatic cholestasis of pregnancy','Total bile acids ≥100 micromol/L','36+0 weeks'], ['Acute fatty liver of pregnancy','Confirmed or suspected','Immediate delivery after maternal stabilization'], ['Chronic kidney disease','Stable renal function, controlled BP, normal fetal growth','No fixed disease-only timing; aim for 39 weeks if otherwise uncomplicated'], ['Chronic kidney disease','Worsening renal function, uncontrolled hypertension, superimposed preeclampsia, FGR, or abnormal testing','Individualize and deliver earlier for maternal or fetal indication'], ['Systemic lupus erythematosus','Quiescent disease, normal renal function, no obstetric complication','No routine early delivery; aim for 39 weeks if stable'], ['Systemic lupus erythematosus','Active nephritis/severe flare, hypertension or preeclampsia, FGR, or abnormal testing','Individualize based on the complication'], ['Antiphospholipid syndrome','Stable, no placental disease','Usually 39 weeks; coordinate anticoagulation plan'], ['Cardiac disease','Stable valvular, congenital, or arrhythmic disease without heart failure','Usually 39 weeks; route based on cardiac and obstetric factors'], ['Cardiac disease','Decompensated heart failure, severe obstruction, aortic risk, pulmonary hypertension, or worsening cyanosis','Individualized early delivery in a tertiary center'], ['Pulmonary hypertension / Eisenmenger syndrome','Significant disease','Highly individualized, often planned 34-36 weeks if stable, earlier for deterioration'], ] other=[ ['Disease / condition','Clinical status','Suggested timing of delivery'], ['Asthma','Well controlled','No indication for early delivery; routine obstetric timing'], ['Epilepsy','Controlled','No indication for early delivery; routine obstetric timing'], ['Thyroid disease','Controlled hypo- or hyperthyroidism','No indication for early delivery'], ['Thyroid storm / severe uncontrolled thyroid disease','Acute severe disease','Stabilize urgently; deliver only for maternal, fetal, or obstetric indication'], ['HIV','Intact membranes and viral load >1,000 copies/mL or unknown near birth','Planned cesarean at 38+0 weeks'], ['HIV','Viral load ≤1,000 copies/mL on effective ART','Vaginal delivery appropriate; routine obstetric timing, generally not before 39 weeks solely for HIV'], ['Active genital herpes','Lesions or prodromal symptoms at labor','Cesarean at onset of labor or rupture of membranes, not at a fixed gestational week'], ['Hepatitis B or C','Uncomplicated infection','No routine early delivery or cesarean solely to prevent transmission'], ] ob=[ ['Condition','Suggested timing of delivery','Key qualifier'], ['FGR, EFW 3rd-10th centile, normal umbilical artery Doppler','38+0 to 39+0 weeks','Singleton, otherwise uncomplicated'], ['Severe FGR, EFW <3rd centile','37+0 weeks',''], ['FGR with decreased diastolic flow','37+0 to 37+6 weeks','Umbilical artery Doppler'], ['FGR with absent end-diastolic flow','33+0 to 34+0 weeks',''], ['FGR with reversed end-diastolic flow','30+0 to 32+0 weeks',''], ['Isolated oligohydramnios','36+0 to 37+6 weeks','Or at diagnosis if later'], ['PPROM','34+0 to 36+6 weeks','Earlier for infection, labor, abruption, or fetal compromise'], ['Term PROM','At diagnosis','Usually induction'], ['Placenta previa, uncomplicated','36+0 to 37+6 weeks',''], ['Placenta accreta spectrum, uncomplicated','34+0 to 35+6 weeks','Experienced center'], ['Vasa previa','34+0 to 37+0 weeks by cesarean',''], ['Dichorionic-diamniotic twins, uncomplicated','38+0 to 38+6 weeks',''], ['Monochorionic-diamniotic twins, uncomplicated','34+0 to 37+6 weeks',''], ] def footer(canvas, doc): canvas.saveState(); canvas.setFont('Helvetica',7); canvas.setFillColor(colors.HexColor('#666666')) canvas.drawString(1.2*cm, 0.65*cm, 'Delivery Timing in Diseases Complicating Pregnancy | Educational reference') canvas.drawRightString(28.4*cm,0.65*cm,f'Page {doc.page}') canvas.restoreState() doc=SimpleDocTemplate(str(out), pagesize=landscape(A4), rightMargin=1.15*cm,leftMargin=1.15*cm,topMargin=1.1*cm,bottomMargin=1.25*cm, title='Delivery Timing in Diseases Complicating Pregnancy', author='Orris') story=[Paragraph('Delivery Timing in Diseases Complicating Pregnancy',styles['DocTitle']),Paragraph('Disease-by-disease quick-reference table | Singleton pregnancy with reliable gestational dating',styles['SubTitle'])] story += [Paragraph('<b>Scope and use.</b> This is an educational summary of commonly used ACOG/SMFM-based suggested timings. “Deliver” may mean induction or cesarean depending on obstetric and maternal indications. Individualize for maternal deterioration, abnormal fetal surveillance, fetal growth restriction, abruption, labor, and local neonatal capability.',styles['Note']),Spacer(1,5)] story += [Paragraph('Hypertensive disorders and diabetes',styles['H']),table(maternal),PageBreak()] story += [Paragraph('Hepatic, renal, autoimmune, and cardiac disease',styles['H']),table(liver),PageBreak()] story += [Paragraph('Other maternal medical conditions',styles['H']),table(other),Spacer(1,8),Paragraph('Fetal, placental, and obstetric conditions that commonly modify delivery timing',styles['H']),table(ob,(7.0*cm,8.0*cm,8.7*cm)),Spacer(1,8)] story += [Paragraph('Deliver without waiting for the planned gestational age when there is eclampsia, HELLP syndrome, acute fatty liver of pregnancy, severe uncontrolled preeclampsia, progressive maternal organ dysfunction, placental abruption or significant hemorrhage, chorioamnionitis, nonreassuring fetal status, or fetal demise.',styles['Note'])] story += [Paragraph('<b>Key:</b> 37+0 means 37 weeks and 0 days. FGR = fetal growth restriction; GDM = gestational diabetes mellitus; PPROM = preterm prelabor rupture of membranes; ART = antiretroviral therapy.',styles['Small'])] story += [Paragraph('Source framework: ACOG/SMFM, <i>Medically Indicated Late-Preterm and Early-Term Deliveries</i> (Committee Opinion 831, 2021, with updates), plus condition-specific guidance. This table is not a substitute for current local protocols or maternal-fetal medicine consultation.',styles['Small'])] doc.build(story,onFirstPage=footer,onLaterPages=footer) print(out) PY python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/delivery-timing-pdf/output/delivery_timing_in_medical_disorders_of_pregnancy.pdf' r=PdfReader(p) print('pages',len(r.pages),'bytes',__import__('os').path.getsize(p)) text=''.join(x.extract_text() or '' for x in r.pages) for phrase in ['Preeclampsia','Intrahepatic cholestasis','FGR','Educational reference']: print(phrase, phrase in text) PY