SERIAL ANTENATAL MONITORING COMPARED WITH LABOR INDUCTION IN POSTTERMPREGNANCIES

Objective. In view of the increased risk of obstetric and perinatal co mplications in post-term pregnancy, and the lack of consensus regardin g clinical routines for fetal surveillance and labor induction, the ai m of this prospective controlled study was to compare obstetric and pe rinatal outcome after serial monitoring until 43 weeks of gestation wi th that after labor induction at 42 gestational weeks. Materials and m ethods. A study group of 193 gravidae scheduled for serial monitoring until 43 weeks of gestation was compared with a control group of 205 g ravidae admitted for induction of labor at 42 weeks. A third, high-ris k, group comprised gravidae (from either of the foregoing groups) who had to be admitted for emergency induction of labor owing to increased fetal risk (i.e., the presence of oligohydramnios or a small-for-gest ational-age fetus). Results. The frequency of labor induction was sign ificantly lower in the study group than among controls (p<0.001), but the two groups did not differ in obstetric or perinatal outcome. As co mpared with these two low-risk groups, the high-risk group was charact erized by significantly higher frequencies of instrumental delivery (p <0.01), operative delivery for fetal distress (p<0.001) and infants re quiring neonatal intensive care (p<0.001). Conclusion. As the wait-and -see policy with serial monitoring resulted in a lower rate of labor i nduction, but not in a lower rate of instrumental delivery or perinata l complication, medically the two routines would appear to be comparab le. However, an individual approach with intensified fetal surveillanc e is to be recommended, as it is vital to identify post-term pregnanci es where the fetus is at increased risk. The use of such new technique s as umbilical artery flow velocimetry would no doubt improve the mana gement of high-risk post-term pregnancies.