PREGNANCY-BIRTH Messages for March, 1999: Re: labor induction at 41.5 wks vs expectant management

Re: labor induction at 41.5 wks vs expectant management

From: William D. McIntosh, MD (anonymous@obgyn.net)
Thu, 18 Mar 1999 16:03:34 -0600 (CST)

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At Tue, 16 Mar 1999, benito wrote: >
>At Sun, 28 Feb 1999, bj wrote:
>>
>>Hello, thankyou in advance for your time.
>>My wife is at 41.5 wks pregnancy. She is scheduled for induction in a
>>few days. The baby was evaluated by u.s. 3 days ago and is fine, and
>>my wife's cervix is 'unfavorable' at this time. This is our second
>>child, our first was delivered by scheduled C section due to breech
>>presentation, transverse incision. We're having second thoughts about
>>the induction, we feel that maybe given a little more time things could
>>progress naturally on their own. We are trying to educate ourselves
>>about the options, our doctor is much too busy it seems to discuss with
>>us what these options might be. From our reading, we are thinking
>>perhaps waiting an additional week might be possible, with twice weekly
>>checkups and daily at-home prostoglandin gel application on or near her
>>cervix. We are having difficulty deciding if this is a wise or a poor
>>decision. In addition, if we were to wait an additional week and labor
>>did not progress, would it then be less risky(at 43.5 wks) to go
>>straight to a C section? We are concerned that the extra week could have
>>a deleterious effect on the placenta, especially if under the influence
>>of exogenous oxytocin during induction. We would greatly appreciate any
>>insight you might be able to offer.
>> Thankyou, B.J. and Margo

The rate of fetal complications begins to rise dramatically between 41 and 42 weeks. This does not mean that you will have problems, just like if you drive without a seat belt you will not necessarily die in a wreck, it just makes it more likely. Expectant management with close monitoring is one option, though it is not my favorite. Home use of prostaglandin gel is not approved, and can lead to severe consequences. There are really very few indications for primary C/S without labor, and this is certainly not one. The question is what are you trying to accomplish? If your goal is a healthy mother and a healthy baby born vaginally, I would lean strongly towards induction now. The extra week WILL have a deleterious effect on the placenta, but oxytocin is oxytocin, whether it comes from an IV or from the mother. They are chemically identical, and no one has ever proven any difference.

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

Next message: William D. McIntosh, MD: "Re: positive test bleeding"
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In reply to: benito: "Re: labor induction at 41.5 wks vs expectant management"
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