Prenatal Care

OB/GYN News, Dec 15, 1999

Some of the greatest challenges we face in counseling obstetric patients surface around the time of their due date.

BRUCE L. FLAMM

What do you say to a woman at 39 weeks' gestation who can no longer stand being pregnant?

What about the patient who is only 1 day past her due date yet feels she is "postdates" and insists on being delivered immediately?

These thorny issues are the focus of this month's column.

The TOP syndrome is not a valid indication for induction of labor.

Dr. Robert Broselow of Lubbock, Tex., who has been in obstetric practice for more than 30 years, sent in this pearl.

He believes that the most common indication for induction of labor--regardless of the official indication--is what he terms the Torments of Pregnancy (TOP) syndrome.

The TOP syndrome includes a constellation of symptoms such as pelvic pressure, soreness in the thighs, insomnia, bloating, trouble walking, and feeling fed up with being pregnant.

Although there is no easy solution to this dilemma, an office nurse or childbirth educator can help your patients deal with these frustrating symptoms and explain that the TOP syndrome is not an indication for delivery

I'd rather treat preeclampsia than posteclampsia.

Dr. John Mirabello, formerly of Tyndall Air Force Base, Panama City, Fla., sent in this clever pearl. Slightly elevated blood pressures are extremely common in late pregnancy and many of these patients don't have preeclampsia. Nevertheless, this pearl reminds us to maintain a high index of suspicion for the disorder.

Warn every pregnant patient to expect false labor.

The labor and delivery suite is not the best place to learn about false labor. A patient who is unaware, of the possibility of false labor and experiences mild contractions at term may come to the hospital, suitcase in hand, expecting to stay until after her baby is born.

Neither she nor her husband will be pleased to learn about false labor at this time. They may pressure the doctor to admit her in spite of an unripe cervix. This in turn may lead to a difficult induction or cesarean section.

The solution is to emphasize early in the pregnancy that false labor is common and that it is normal to be sent home from the hospital at term if the cervix is not dilating.

Remind pregnant women that the due date is only an estimate.

Dr. Bob DeMott of Green Bay Wis., takes this step further. He gives a "due month" instead of a due date. I don't go that far but I do dearly explain to the patient that the due date is only an approximation.

I stress that just because the ultrasound machine happens to say, "EDC = 07/04/00" does not mean that the baby will be born on or before the 4th of July. If not warned about this, a pregnant patient may be inordinately impressed by complex ultrasound technology and conclude that her ultrasound-confirmed due date is scientifically certain. If she then goes one day past this date, she may mistakenly believe that something is terribly wrong.

DR. BRUCE L. FLAMM is area research chairman and a practicing ob.gyn. at the Kaiser Permanente Medical Center in Riverside, calif.