elitoki
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I found a question in UW that said something like...
...42wks gestational with fundal height consistant with date, cervix not favorable, USG NL, A.F. Index 10, fetal heart tracing is reassuring. What is next step?
A) NST twice wkly and Biophysical profile
B) Immediate induction of labor
C) Amnioinfusion and wait for spontaneous delivery
D) Cesarean
I thought B) induction of labor but they said A.
Could someone help me, plz.
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| Drtweetie
Forum Elite
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Postdate pregnancy def: >42 wks after first day of LMP
Management classified into 3 groups depending on confidence in dates and favorableness of cervix:
1) Dates sure, favorable cervix: aggressive management i.e labor induction with iv oxytocin and artificial ROM
2) Dates sure, unfavorable cervix: controversial management; could be aggressive with labor induction or conservative with twice wkly NST and AFI
3) Dates unsure: conservative management
I encountered this question in UW also, and my answer was the same as yours--labor induction. This pt fits category #2, but UW said usually dates are unsure, so follow up with NST and BPP until she's 43 wks.
Anyone has anything else to add??
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| Eric1979
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Hi, I just saw this site by chance and saw your question. I'm an ObGyn resident in Canada and I actually did a review on this subject. If you really have no idea about the dates, it's a different thing. But usually, you either know the LMP dates or if you don't you did an US in the first trimester or even then you have to have done an US for the fetal anatomy around 20 weeks... you'll have an estimate +or- 7-10 days with that one. So basically, you always know the dates!
And if you know the dates and you're at 41 weeks.... you need to either induce or follow the baby closely with NonStress tests and an US. Although labot induction is still rpeferable no matter how the cervix is.... favorable or not. If not favorable, you mature the cervix.... And once you're at 42 weeks, you're supposed to induce no matter what. The risks are far greater than the benefits if you prolong the gestation.....
Hope it helps (although it contradicts the given answer)....
Good luck on you test!
Eric
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| elitoki
Forum Guru
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Thanks for your helps~ 
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| doyoudig
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question is ridiculous b/c where does is say that dates are unsure
Normally 1st US is always the correct one, hence any US done after that is not for dates but rather fetal/maternal probs
agree eric, UW people drive u nutty at times w/ their explanations
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| claudia_i
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Postdate pregnancy means >42 wks, so I think that we should wait until the end of week 42 to induce labor. That's just a thought. Why did the UW say choice B was incorrect?
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| drbin
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it seems like they want the answer like we wait till 42 wks are over ie until 43 wks with twice weekly NST and BPP. Seems only theoretical....
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