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Re: Postdates was Reality OBFrom: David Rivera (cuurmudgeon@sbcglobal.net)Sun Jun 12 18:46:47 2005
For those of you doing the ABC exam, one of the articles is "Management of Postterm Pregnancy." It basically says there is little rationale other than medicolegal fear for what we do. "When should antepartum fetal testing begin? Because of ethical and medicolegal considerations, no studies have included postterm patients who were notpostmonitored; it is unlikely that any future studies will include an unmonitored control group. The published studies are of insufficient power to demonstrate a benefit of monitoring. However, there is no evidence that antenatal fetal monitoring adversely affects patients experiencing postterm pregnancy. Data suggest a gradual increase in perinatal morbidity and mortality during this period (Fig. 1) (10). Therefore, despite evidence that it does not decrease perinatal mortality, antenatal fetal surveillance for postterm pregnancies has become a common practice on the basis of universal acceptance. Patients who have passed their EDD but who have not yet reached 42 weeks of gestation constitute another group for whom antenatal fetal surveillance has been proposed. Some studies report a greater complication rate among women giving birth during the latter half of this 2-week period (21–23, 28, 29). However, no randomized controlled trial has demonstrated an improvement in perinatal outcome attributable to fetal surveillance between 40 and 42 weeks of gestation (30). Despite the lack of evidence demonstrating a beneficial effect, antenatal fetal surveillance often is performed during this period. To further complicate matters, in most studies of postterm pregnancies, women are recruited and fetal monitoring initiated before 42 weeks of gestation(31–36). Finally, there is insufficient evidence to indicate whether routine antenatal surveillance of low-risk patients between 40 and 42 weeks of gestation improves perinatal outcome (2, 28)." Henry Gregor <henrygregor@yahoo.com> wrote: A couple of years ago, while at a Parkland Hospital (Dallas, TX...home of the Williams Obstetrics text for those not familiar) Dr. Leveno and other staff presented their data on postdates surveillance regimens...bottom line, they decided delivery should be offered and encouraged at 41 weeks, secondary to preventable poor outcomes, despite any known protocols used by them, or published by others, if one went to 42 weeks. Hank "R. Daniel Braun" <rd.braun@gmail.com> wrote: They don't get to tell you what THEY want at 42 weeks? Stats show they don't do well atfter 41 weeks too. On 6/12/05, Barbara Parker <midwifebarb@yahoo.com> wrote: I get an EFW/AFI at 40 weeks, just to be sure we are not growing an elephant. Then, if it seems reasonable, we do NST at 40 weeks, and let everyone go to 41. At 41, you get an NST and BPP, and the patient gets to tell me what THEY want. If they want induction, that's what we do. If not, NST agagin at 41 1/2, and EVERYONE gets inducted at 42 weeks. Period. No one goes past that... Stats show that babies do BADLY after 42 weeks. That's just my philosphy... Barb, CNM Tired of spam? Yahoo! Mail has the best spam protection around
--
R. Daniel Braun
Kinky for Governor
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