The management of prolonged pregnancy - an analysis of women's attitudes before and after term

Article Abstract:

Prolonged pregnancy (a pregnancy that continues several days past the due date) is often treated by routine induction of labor after 10 days or more, but recent evidence suggests that the decision to induce may be influenced by somewhat arbitrary criteria. Many women want to avoid obstetrical intervention whenever possible. To learn more about women's attitudes regarding prolonging their pregnancies with conservative medical management, a study was carried out with 500 women. The subjects were 37 weeks pregnant when the study began. They received written information informing them of the prenatal clinic's new policy, which was to offer them the option of continuing their pregnancy under careful supervision after the 42nd week of gestation. Each woman completed a questionnaire indicating her preference for induction of labor or conservative management. During week 37, 226 (45 percent) agreed to conservative management. By 41 weeks' gestation, 122 women (24.4 percent) had not delivered. Thirty-eight of these (30 percent) wanted conservative management, a significant shift when compared with attitudes expressed earlier in pregnancy. All changes in desired care were away from conservative management; no subjects changed to this position. Reasons (at 37 weeks' gestation) for not wanting conservative management included: inability to stand the thought of being pregnant for more than 42 weeks (34 percent); perception of no benefit to waiting (21 percent); concern regarding fetal size (20 percent); and no family member available after 42 weeks' gestation (20 percent). The subjects' opposition to conservative management is discussed; such a position is of particular concern when the fetus's gestational age is unknown. It is recommended that the concept of 'expected due date' be abandoned, since women often become alarmed if the baby has not arrived by that date. It is concluded that pregnant women, as well as the medical profession, are inclined to chose induction of labor for prolonged pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

User Contributions:

1

Bichok Lueng

Aug 8, 2009 @ 10:22 pm

I am really very concern,my wife as I am writing has been pregnant since mid june last year, I mean since 2008. In Oct the same year she had a partial miscarriage that was after almost months of pregnancy. I wasn't quite sure the diagnosed because I live in USA and she lives in Kenya. As a result of that she left for Sudan where we both from and the medical was so poor for her as the result she was so sick and eventually she came back to kenya where she was finally diagnosed with UTI which affected her kidney and baby was still a live with severals months of bleeding. Now she is under doctor surpvision and doctor is saying she deliver normally when the time come, so I am wondering in this problem what should be done to my wife given the situation that baby is not yet grown. I am sorry for giving you guys what was not even a topic , but are relevant. I hope some body will give what to do next. Thanks.

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Repeated measurement of maternal weight during pregnancy. Is it a useful practice?

Article Abstract:

The procedure of weighing pregnant women on a routine basis was started in London in the 1940s in an attempt to monitor the nutritional status of the mother. Although studies have shown a relationship between maternal weight gain and infant birthweight, there is little evidence to suggest that the routine weighing is a useful method for identifying women at risk for having a low birthweight (LBW) infant or an infant that is small for its gestational age (SGA). To determine the relationship between maternal weight gain and infant birth weight, a retrospective study of 1,092 pregnant women was performed. A low maternal booking weight (less than 110 pounds) was the most predictive factor for giving birth to an SGA infant, with a predictive value of 20 percent. An average maternal weekly weight gain of less than a half of a pound had a predictive value of 13 percent for identifying SGA infants, and smoking had a predictive value of 16 percent. After accounting for the length of gestation, maternal age, smoking status and previous births, maternal weight changes occurring between weeks 28 and 32, 32 and 36, and 28 and 36 were not associated with infant birth weight. It is concluded that the routine weighing of pregnant women is unnecessary and has little predictive value for identifying women at risk for having SGA infants. Maternal weight should be measured only at initial office visit. (Consumer Summary produced by Reliance Medical Information, Inc.)

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