[The importance of clinically detectable ketonuria in patients with post-term pregnancy].

The aim of this study was to ascertain whether the notable ketonuria in patients with postterm pregnancy can be associated with abnormal fetal assessment tests. The 207 pregnant patients with postterm pregnancy after 41 gestation week have been included in the medical survey after testing their urine: including ketons, glucose, pH, albumen and individual weight. 24 patients in this study have been diagnosed with maternal ketonuria (11.59%). The ketonuria in patients with postterm pregnancy directly correlates to abnormal results of fetal heart rate tests, Nonstress test, amniotic fluid index, placenta grading III. The importance of clinically notable ketonuria in patients with postterm pregnancy is discussed.

The influence of maternal ketonuria on fetal well-being tests in postterm pregnancy.

BACKGROUND: Although it is well-known that postterm pregnancies are associated with the risk of perinatal morbidity and mortality, a comprehensive study on its management is lacking. The aim of present study was to determine whether ketonuria is associated with abnormal fetal test results in pregnancies >40 weeks of gestation. METHODS: In this analytical cross sectional study, a total of 360 pregnant women with gestational age of >40 weeks were evaluated in two hospitals during 2003 - 2004. For each woman, urinary ketones, glucose, pH, proteins, and specific gravity were measured by total screen LSG tapes (Rapignost); in addition, biophysical profile test was recorded and the amniotic fluid index was assessed by ultrasonography. RESULTS: Ketonuria was found in 34 women (9.44%). Statistical analyses showed that maternal ketonuria was associated with oligohydramnios, abnormal fetal tests, and a significant increase in fetal heart rate decelerations. CONCLUSION: Patients with clinically-detectable ketonuria have higher risk for abnormal fetal tests in comparison with those without the disease.

The impact of maternal ketonuria on fetal test results in the setting of postterm pregnancy.

OBJECTIVE: The aim of this study was to determine whether ketonuria, a commonly assessed urinary marker of maternal starvation and dehydration, is associated with abnormal fetal test results in the setting of postterm pregnancy. STUDY DESIGN: During a 4-year period (January 1993-December 1996), a total of 3655 visits for antepartum maternal-fetal testing of postterm pregnancies (> or =41 weeks' gestation) occurred at our institution. Maternal assessment included vital signs and urinalysis. The presence and degree of maternal ketonuria was correlated against abnormal results of fetal heart rate tests, nonstress tests, amniotic fluid index measurements, and biophysical profile scores performed on the same day. RESULTS: There were 3601 encounters suitable for inclusion in the study. Clinically detectable ketonuria occurred in 10.9% of the patients studied. Patients with clinically detectable ketonuria were at increased risk relative to patients without ketonuria for abnormal outcomes during postterm testing, including the presence of oligohydramnios (24% vs. 9.3%; P<.0001 ), nonreactive nonstress tests (6.2% vs. 2.15%; P<.0001), and fetal heart rate decelerations (14% vs 9.2%; P =.0039 ). CONCLUSION: Maternal ketonuria among patients with postterm pregnancy was associated with a >2-fold increase in the occurrence of oligohydramnios, a 3-fold increase in nonreactive nonstress tests, and a significant increase in fetal heart rate decelerations. Further studies are required to evaluate the potential benefits of treating ketonuria before fetal testing.

Prediction of oligohydramnios in prolonged pregnancy.

A decrease in amniotic fluid in prolonged pregnancy is associated with increased fetal morbidity. However, few investigations have been reported on the prediction of this condition. Fetal renal arterial pulsatility index (PI), hourly fetal urine production rate (HFUPR) and amniotic fluid index (AFI) at 39 weeks were studied in 51 singleton pregnancies with (n = 14) and without oligohydramnios (AFI < 5, n = 37) in prolonged pregnancy. There was no difference in the average fetal renal arterial PI and HFUPR between the oligohydramnios group and the normal group. However, the average AFI in the oligohydramnios group was 7.5 +/- 0.9, which was lower than that in the normal group (p < 0.05). We speculated that AFI value at 39 weeks is useful for predicting the incidence of oligohydramnios in prolonged pregnancy.

A randomized trial of induction at 42 weeks gestation versus expectant management for postdates pregnancies.

A randomized prospective clinical trial of induction of labor at 42 completed weeks gestation versus expectant management in postdates pregnancies was performed. The primary screening test was the 24-hr urinary estriol creatinine ratio. The cesarean section rate was high in both groups and did not differ statistically. Intervention by delivery at 42 weeks decreased the development of small for gestational age infants, but costs slightly more. Twenty-four-hour urinary estriol creatinine ratio determinations predicted fetal distress in labor, but could not predict postmaturity syndrome or infants who were small for gestational age. As expectant management did not differ from induction of labor at 42 weeks from the standpoint of maternal outcome, and as the cost difference was small, induction of labor at 42 weeks may be the preferred management as it improves infant outcome.