To
Editor-in-Chief
Journal of Bangladesh College of Physicians and
Surgeons.
Sir,
I would like to thank you for publishing the article ‘
Maternal Outcome of Prolonged Pregnancy’. I have
gone through it and found the content nice. I would like
to share some of my observations and comments.
Post-term or prolonged pregnancy is defined as one
that exceeds 294 days (42 weeks) from the first day of
the last normal menstrual period1,. Because population
studies indicate that in healthy women with otherwise
uncomplicated pregnancies perinatal mortality and
morbidity is increased beyond 42 weeks gestation1,2
.There is risk of meconium aspiration, birth injury ,
hypoxia and stillbirth. There is also maternal concern
about delay past expected date of delivery3.
Pregnancy cannot be said to be prolonged without
accurate dating. There is considerable variation in the
way that the expected date of delivery is determined. It
is known that the LMP even when recalled with
confidence, can result in considerable dating error4.
Using scan dates will result in fewer pregnancies being
considered post-term5. An early USG (<14weeks) for
dating is recommended for all women. This will reduce
the number of women assumed ‘post-term’. If an early
ultrasound (<14weeks) is available the estimated date
of delivery (EDD) should be calculated from ultrasound,
ignoring the last known menstrual period (LMP). If
ultrasound performed > 14weeks gestation the EDD
should be calculated from LMP( if known) unless
ultrasound differs more than one week. In women with
oligomenorrhea, lactational amenorrhea or oral
contraceptive withdrawal bleeding where a calculation
cannot be based on the menstrual history, the first
ultrasound prediction becomes the EDD1.
Active induction does not appear to increase the
caesarean section rate.Rather it is suggested that
induction of labour(IOL) for prolonged pregnancy
results in a reduction in caesarean section rate6,7.It is
now common practice to offer induction of labour to all
women at 7 days past the due date2. Women should be
informed that most women will go into labour
spontaneously by 42 weeks. At the 38 week antenatal
visit, all women should be offered information about
the risks associated with pregnancies that last longer
than 42 weeks, and their options. The information should
cover the advantages and disadvantages of membrane
sweeping1,8. Membrane sweeping makes spontaneous
labour more likely, and so reduces the need for formal
induction of labour to prevent prolonged pregnancy and
not associated with an increase in maternal or neonatal
infection or major adverse events. As it requires a
vaginal examination, women may experience discomfort
during the procedure with vaginal bleeding and
contractions that do not lead to labour during the
24hours following the procedure.
At a visit close to 41 weeks gestation, for a women in
whom an IOL is planned for around 42 weeks twice
weekly fetal surveillance(AFI & CTG) should be done.
Women with uncomplicated pregnancies should usually
be offered induction of labour between 41+0 and 42+0
weeks to avoid the risks of prolonged pregnancy. The
exact timing should take into account the woman’s
preferences and local circumstances. If a woman chooses
not to have induction of labour, her decision should be
respected. Healthcare professionals should discuss the
woman’s care with her from then on. From 42 weeks,
women who decline induction of labour should be
offered increased antenatal monitoring consisting of at
least twice-weekly cardiotocography and ultrasound
estimation of maximum amniotic pool depth1,8.
Overall I think the article is updated, informative. Iwould
like to thank the authersfor their hard work.