Are we there yet? The last few weeks of pregnancy can seem endless, and it’s tempting to ask your doctor to induce labor to get the whole thing over sooner
—especially in the hot, uncomfortable summer months. Or perhaps your obstetrician will be going out of town soon, and he suggests bringing on labor when you get near your due date. But maybe you shouldn’t try to fool with Mother Nature. Investigators have found that when women undergo elective induction, they are more than twice as likely to have a cesarean delivery, according to the authors, who recently published their findings in the journal Obstetrics Gynecology. When women giving birth for the first time have an elective induction, they are almost three times as likely to end up with a cesarean.
And cesarean deliveries are not without risk. Compared to women who have regular vaginal deliveries, those who have cesareans are nearly twice as likely to be back in the hospital within 60 days, according to a study in a May issue of the Journal of the American Medical Association. Cesarean births carry the risk of life-threatening blood clots, excessive bleeding, infection, and tearing of the uterus or of the surgical incision, among others.
Most postdate babies are not post mature. “Women have been subjected to the hazards and emotional hardships of an induced labor without apparent benefit.” Except when done between six and 12 weeks menstrual age, ultrasound dating has a margin of error greater than dating by LMP. Primiparous women average longer pregnancies than multiparas, and the average gestational length is longer than 280 days. All clinical dating methods, including the LMP, have margins of error of more than two weeks. Comparing the LMP to ovulation dates from basal body-temperature records, one study found that 70% of pregnancies classified as postdates were misclassified. Another found the proportion of pregnancies classified as postdates by the LMPwas 15.5% versus 4.5% by ovulation date. Only two of 110 babies were post mature, and one was not postdate. One day should be added for everyday the cycle exceeds 28 days.
We have no accurate way to identify postdate fetuses at risk. Fetal movement counts are not sensitive enough. Neither hormonal assays nor placental grading are reliable. The incidence of meconium-stained fluid increases abruptly at 38 weeks, but this relates to maturing reflexes, not distress. Oligohydramnios associates with growth retardation, thick meconium, and fetal distress and may have value
[but false-positive rates are high]. The CST appears to have a lower false-negative rate than the NST, but this is based on nonrandomized studies. Several studies have shown nipple stimulation to be as safe and reliable as an oxytocin drip for the CSYT as well as cheaper, easier, and faster. The biophysical profile accurately predicts fetal distress at extreme ends of its scale. [What about midrange scores?]
Two studies found no increase in abnormal FHR with postdatism. Studies of management have not found that tests accurately identify postmature babies or that routine induction improves perinatal outcome. Epidemiologic studies have found that much of the excess perinatal mortality in the postdate population is due to outer factors: congenital anomalies, infection, or IUGR. The postmature infant is relatively rare. About 10% of pregnancies are postdates, of which 5% to 26% result in postmature babies.
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