Management of postterm pregnancy: Number 6, October 1997

Abstract

Simple titration of urinary estriol and of serum human placental lactogen (HPL) has recently proved valuable in the assessment of feto-placental function, and the non-stress test (NST), the contraction-stress test (CST), and other fetal reserve tests are now routinely used in the management of post-term pregnancy. Major progress has also been made in labor induction using prostaglandin and DHAS. Despite these advances, however, the prognosis of post-term fetus has not improved during the past five years at our department. Our statistical data indicate room for improvement in the management of post-term pregnancy, but independently of new methods of fetal assessment or of labor induction. The management of post-term pregnancy appears to have entered a new stage of development. Ultrasonic echography has made it possible accurately to estimate gestational age, and hence the date of conception, early in pregnancy and thus to exclude false post-term pregnancies. The post-term pregnancy rate was once as high as 7%. More than half of these cases were false and were often subject to unnecessary induction of labor. Echographic screening and correction of date of conception have now reduced the true incidence of post-term pregnancy to between 1.5% and 3.1%. Echographic screening should therefore be performed for this purpose whenever possible. The diagnosis of oligohydramnios has also been facilitated by ultrasonic echography for the semiquantitative measurement of amniotic fluid. It has been reported, for example, that the volume of amniotic fluid tends to decrease after the 38th week of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)