How safely can we follow up post-term pregnancy with uncertain gestation using amniotic fluid index measurement

[摘要] ENGLISH ABSTRACT: Background:Studies about management of prolonged pregnancy dealt with pregnancy with certain gestational age, confirmed with early ultrasound scans.Objective: The primary aim for the study is to review the current management of uncertain gestational age (GA) post term pregnancy in Tygerberg Academic Hospital (TBH). Women at 42 weeks with an uncertain GA and an amniotic fluid index (AFI) of ≥ 10 cm as well as reassuring cardiotocographs (CTG) would be assessed to determine whether follow up over one week or two weeks are required.Method:A retrospective descriptive study included all patients with an uncertain gestation of 42 weeks referred to TBH.Results:A total of 135 pregnant women were studied. Booking fundal height (BFH) was used to determine GA in 99% and last menstrual period (LMP) in 1% of patients. The time interval between first evaluation at 42 weeks and delivery varies between 0 to 46 days (median 10 days); 104 women delivered vaginally (71% spontaneously, 6% after induction of labour (IOL)); 31 women (23%) by caesarean section; 1 elective, 4 due to cephalopelvic proportion (CPD), 5 had failed IOL, 3 poor progress and 18 fetal distress. Out of the total 11 (8%) women with AFI ≥ 10 had caesarean sections for fetal distress within 2 weeks of the visit at 42 weeks. No neonatal morbidity or mortality was noted in this study.Conclusion:Weekly monitoring with AFI and CTG for women at 42 weeks with unsure gestation is safe. A follow-up following 2 weeks cannot be recommended as 8% of women required caesarean sections within less than 2 weeks due to fetal distress.

[发布机构] Stellenbosch University