The outcome of post-term pregnancy. A comparative study

Management of pregnancy in a university hospital: a 6-year study

In order to evaluate the obstetric care in the Obstetric Clinic of the Gynaecology and Obstetrics Department of University of Sao Paulo, the authors present a survey of the management of pregnancy during the 6-year period from 1993 to 1998. The number of deliveries increased during the study by 45% over the 6 years. During this same period the number of fetal deaths was 526 (4.48%), but there was a significant decrease (p < 0.05) in the incidence of fetal death. However, there was no concomitant increase in the proportion of pregnant women with prenatal care that could explain this improvement. Incidence of premature labor also decreased considerably. The authors believe that the increment in the number of deliveries was due mainly to the increasing number of pregnant women referred to our service. The efforts made by the service towards decreasing the time of hospitalization of both newborns in the nursery and the mothers in the hospital made this possible. Despite the increasing number of deliveries, there was a significant improvement in the management of pregnancy during the period of study. This improvement may be a consequence of the standardization of a protocol of management of pregnancy based on the recent progress in scientific and technological knowledge.

Estimating fetal weight in the management of macrosomia

The purpose of this review is to examine the evidence that, including estimates of fetal macrosomia in patient care, will decrease adverse perinatal outcomes. A literature search for the years 1980 to 1999 was used. Shoulder dystocia and brachial plexus injuries occur more often in macrosomic than in non-macrosomic neonates. However, 26 to 58 percent of shoulder dystocias and 24 to 44 percent of brachial plexus injuries occur to babies weighing less than 4000 gm. Persistence of impairment is extremely rare. Neither historical nor clinical factors have strong positive predictive values for macrosomia. From 15 to 81 percent of the babies predicted to be macrosomic are confirmed by birth weight. Of babies determined to be macrosomic at birth, only 50 to 100 percent were successfully predicted. Shoulder dystocia and brachial plexus injuries are unpredictable events. Available evidence suggests that planned interventions based on estimates of fetal weight do not reduce the incidence of shoulder dystocia and do not decrease adverse outcomes attributable to fetal macrosomia.