Almström H, Granström L, Ekman G
Karolinska Institutet, Danderyds Hospital, Division of Obstetrics and Gynecology, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 1995 Sep;74(8):599-603. doi: 10.3109/00016349509013469.
In view of the increased risk of obstetric and perinatal complications in post-term pregnancy, and the lack of consensus regarding clinical routines for fetal surveillance and labor induction, the aim of this prospective controlled study was to compare obstetric and perinatal outcome after serial monitoring until 43 weeks of gestation with that after labor induction at 42 gestational weeks.
A study group of 193 gravidae scheduled for serial monitoring until 43 weeks of gestation was compared with a control group of 205 gravidae admitted for induction of labor at 42 weeks. A third, high-risk, 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-gestational-age fetus).
The frequency of labor induction was significantly lower in the study group than among controls (p < 0.001), but the two groups did not differ in obstetric or perinatal outcome. As compared with these two low-risk groups, the high-risk group was characterized by significantly higher frequencies of instrumental delivery (p < 0.01), operative delivery for fetal distress (p < 0.001) and infants requiring neonatal intensive care (p < 0.001).
As the wait-and-see policy with serial monitoring resulted in a lower rate of labor induction, but not in a lower rate of instrumental delivery or perinatal complication, medically the two routines would appear to be comparable. However, an individual approach with intensified fetal surveillance is to be recommended, as it is vital to identify post-term pregnancies where the fetus is at increased risk. The use of such new techniques as umbilical artery flow velocimetry would no doubt improve the management of high-risk post-term pregnancies.
鉴于过期妊娠时产科及围产期并发症风险增加，且在胎儿监护及引产的临床常规方面缺乏共识，本前瞻性对照研究旨在比较妊娠43周前进行连续监测后的产科及围产期结局与妊娠42周时引产的结局。
将计划进行连续监测直至妊娠43周的193名孕妇组成的研究组与妊娠42周入院引产的205名孕妇组成的对照组进行比较。第三个高危组由因胎儿风险增加（即羊水过少或小于胎龄儿）而必须入院进行紧急引产的孕妇（来自上述任何一组）组成。
研究组的引产频率显著低于对照组（p < 0.001），但两组在产科或围产期结局方面无差异。与这两个低风险组相比，高危组的器械助产频率（p < 0.01）、因胎儿窘迫进行手术分娩的频率（p < 0.001）以及需要新生儿重症监护的婴儿频率（p < 0.001）显著更高。
由于连续监测的观望政策导致引产率较低，但器械助产率或围产期并发症率并未降低，从医学角度来看，这两种常规方法似乎具有可比性。然而，建议采用强化胎儿监测的个体化方法，因为识别胎儿风险增加的过期妊娠至关重要。使用脐动脉血流速度测定等新技术无疑将改善高危过期妊娠的管理。
