Postdate fetal surveillance: Is 41 weeks too early?

Article Abstract:

Normal pregnancies deliver infants by the 40th week of pregnancy (normal gestation). The health of the fetus is greatly compromised after 42 weeks gestation. Lack of placenta may occur, causing impaired fetal oxygen supply, diminished or absent amniotic fluid surrounding the fetus, aspiration of meconium (contents of fetal intestines forming the first stool), neurological damage and death. Fetal testing, including ultrasound, the use of high frequency sound to visualize fetal abnormalities, and fetal monitoring routinely begin at 42 weeks from the woman's last menstrual period. On the basis of this monitoring, it is decided which postdate pregnancies should have an induced delivery. Placental insufficiency may be progressive and actually begin earlier than 42 weeks. Earlier fetal testing may be beneficial in the 41-42 week period. Significant increases in complications in weeks 41-42 require transfer to intensive care facilities. Poor pregnancy outcomes and abnormal fetal test results common in 42 week gestation were also found in 41-week pregnancies. A very low number of abnormal tests appeared in the 39 to 41-week group. Therefore, earlier postdate fetal testing should be implemented to improve the chances of the fetus.

Analysis, Evaluation, Prevention, Fetal heart rate monitoring, Electronic fetal monitoring, Pregnancy, Complications of, Pregnancy complications, Amniotic fluid, Placental diseases, Placenta diseases

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Low-dose versus high-dose oxytocin augmentation of labor - a randomized trial

Article Abstract:

The use of high-dose oxytocin might reduce the rate of cesarean sections without increasing the incidence of birth complications. Oxytocin is used to induce labor when the cervix fails to dilate at term. Of 310 women at 37 weeks gestation or greater who were eligible for induced labor, 156 were given low-dose oxytocin and 154 were given high-dose oxytocin. Low-dose oxytocin consisted of an infusion of 1 milliunits per minute (mU/min) and increasing up to 4 mU/min. High-dose oxytocin consisted of 4 mU/min and higher doses until the uterus began to contract. High-dose oxytocin reduced the cesarean rate substantially with no increase in complications of labor or fetal distress. High-dose oxytocin also reduced the time it took for the cervix to dilate.

Dosage and administration, Oxytocin

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Antepartum cervical ripening: applying prostaglandin E2 gel in conjunction with scheduled nonstress tests in postdate pregnancies

Article Abstract:

A vaginal gel containing prostaglandin E2 may be effective in ripening the cervix in some women with prolonged pregnancies. Cervical ripening is the term used for the softening of the cervix, which must occur if it is to open wide enough to allow the baby to pass through the birth canal. Researchers randomly assigned 90 women past their due date to receive a vaginal gel containing prostaglandin E2 or a placebo at the time they came for fetal heart rate monitoring. Women with a Bishop score between 3 and 6 who received prostaglandin E2 required fewer labor inductions compared to the other groups.

Health aspects, Care and treatment, Prostaglandins E

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