title: Elective delivery before 39 weeks' gestation: reconciling maternal, fetal, and family interests in challenging circumstances.
abstract: We present the case of a 36-year-old woman who has experienced three lost pregnancies; during the most recent loss, a full term pregnancy, she almost died from complications of placental abruption. She is now completing the 34th week of gestation and is experiencing symptoms similar to those under which she lost the previous pregnancy. Despite a lack of specific medical indications, the patient and her husband firmly but politely request that the attending obstetrician/perinatologist perform an immediate cesarean section in order to alleviate the couple's anxiety about possibly never having a family. Discussing the case are an experienced perinatologist, a neonatologist, a regional perinatal center coordinator, and a clinical ethicist.
authors.affiliation: Center for Medical Humanities, Compassionate Care, and Bioethics, Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York, USA. stephen.v.mccrary@stonybrook.edu
authors.forename: S
authors.initials: S
authors.lastname: Van McCrary
authors.forename: Shetal I
authors.initials: SI
authors.lastname: Shah
authors.forename: Adriann
authors.initials: A
authors.lastname: Combs
authors.forename: J Gerald
authors.initials: JG
authors.lastname: Quirk
mesh_terms: D000022:Abortion, Spontaneous; D000037:Abruptio Placentae / Q000517:prevention & control; D000328:Adult; D002585:Cesarean Section; D002755:Choice Behavior / Q000941:ethics; D003071:Cognition; D003657:Decision Making / Q000941:ethics*; D006233:Persons with Disabilities; D004644:Emotions; D033061:Ethics Consultation / Q000592:standards; D005190:Family; D005260:Female; D005313:Fetal Death; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal / Q000191:economics / Q000379:methods; D008297:Male; D010290:Parents / Q000523:psychology; D010348:Patient Care Team / Q000941:ethics; D010817:Physician-Patient Relations / Q000941:ethics*; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics; D014481:United States