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Antepartum testing in postterm pregnancy.

T J Benedetti1, T Easterling

  • 1Department of Obstetrics and Gynecology, University of Washington, University Hospital, Seattle 98195.

The Journal of Reproductive Medicine
|March 1, 1988
PubMed
Summary
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No single antepartum testing method uniformly prevents all antepartum deaths in postdate pregnancies. Ultrasound with a 3-cm pocket showed the lowest perinatal mortality, followed by weekly contraction stress tests.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatology

Background:

  • Postdate pregnancy, defined as beyond 42 weeks gestation, carries increased risks.
  • Antepartum surveillance aims to reduce fetal and neonatal mortality in high-risk pregnancies.
  • The effectiveness of various antepartum testing methods in postdate pregnancies requires ongoing evaluation.

Purpose of the Study:

  • To review and compare the efficacy of different antepartum testing methods in postdate pregnancies.
  • To identify testing strategies associated with lower perinatal mortality rates.
  • To inform clinical decision-making regarding fetal surveillance in pregnancies exceeding 42 weeks.

Main Methods:

  • Review of antepartum testing methods used in postdate pregnancies.

Related Experiment Videos

  • Comparison of perinatal mortality rates associated with different testing modalities, including ultrasound (3-cm and 1-cm pocket) and contraction stress tests.
  • Analysis of non-stress test (NST) outcomes, considering interpretation of variable decelerations.

    • Main Results:

    • No single antepartum test uniformly prevents all antepartum deaths in pregnancies >42 weeks.
    • Ultrasound with a 3-cm vertical pocket demonstrated the lowest perinatal mortality (1.8/1,000).
    • Weekly contraction stress tests showed comparable low mortality (2.5/1,000), while biweekly NSTs had higher rates (5-6/1,000), significantly increasing if variable decelerations were not considered abnormal (15/1,000).

    Conclusions:

    • The choice of antepartum testing method and institutional practices influence perinatal outcomes in postdate pregnancies.
    • Ultrasound with a 3-cm pocket and weekly contraction stress tests appear to be the most effective methods for reducing perinatal mortality.
    • Induction of labor at 41-42 weeks may be a viable alternative to antepartum testing in selected patients with favorable Bishop scores.