Prolonged Pregnancy: Is It or Isn't It?

The management of prolonged pregnancy still remains controversial, although most now accept that perinatal mortality and possibly morbidity are increased when pregnancy exceeds 42 weeks gestational age. Accurate diagnosis must commence with the first prenatal visit, since retrospective documentation is impossible. Except for elective induction of a few special high risk pregnancies, the problem can be well managed with the use of frequent urinary estriol determinations and selective amniocentesis. Careful monitoring and detection of fetal distress with early intervention are essential in eliminating this problem with elective cesarean section in a selected few. A combination of low estriols and prolonged pregnancy should always be an indication for maternal X-ray to eliminate anencephalic monsters.