シンポジウム形式 : 過期妊娠の取り扱いについて : 過期妊娠の管理をめぐる問題点

NDLデジタルコレクション

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タイトル別名
  • Management of Post-term Pregnancy

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Simple titration of urinary estriol and of serum human placental lactogen (HPL) has recently proved valuable in the assessment of feto-placental function, and the non-stress test (NST), the contraction-stress test (CST), and other fetal reserve tests are now routinely used in the management of post-terrn pregnancy. Major progress has also been made in labor induction using prostaglandin and DHAS. Despite these advances, however, the prognosis of post-term fetus has not improved during the past five years at our department. Our statistical data indicate room for improvement in the management of post-term pregnancy, but independently of new methods of fetal assessment or of labor induction. The management of post-term pregnancy appears to have entered a new stage of development. Ultrasonic echography has made it possible accurately to estimate gestational age, and hence the date of conception, early in pregnancy and thus to exclude false post-term prances. The post-term pregnancy rate was once as high as 7%. More than half of these cases were false and were often subject to unnecessary induction of labor. Echographic screening and correction of date of conception have now reduced the true incidence of post-term pregnancy to between 1.5% and 3.1%. Echographic screening should therefore be performed for this purpose whenever possible. The diagnosis of oligohydramnios has also been facilitated by ultrasonic echography for the semi-quantitative measurement of amniotic fluid. It has been reported, for example, that the volume of amniotic fluid tends to decrease after the 38th week of pregnancy. Both oligohydramnios and compression of the umbilical cord are considered causes of fetal distress, because variable decelerations in the fetal heart rate are almost always seen in cases of post-term pregnancy fetal distress. Although no consensus has been reached on the criteria for diagnosis of oligohydramnios by echography and on the best therapeut ic approach to variable deceleration, both echographic measurement of amniotic fluid volume and urinary estriol titration should be routinely screened in post-term pregnant patients. A way has yet to be found to discriminate false and true post-term pregnancies, and even among true post-term prances, some are probably physiological while others are pathological, involving placental dysfunction, fetal overgrowth, and fetoplacental disproportion. Diagnosis and treatment should therefore be individualized according to the cause of the disorder.

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