A study of induction of labour versus expectant management for pregnancies beyond 40 weeks a prospective comparative randomised study

Abstract

Introduction: Post-term pregnancy is one that extends to or beyond 42 weeks of gestation, Patients at 40 weeks can either undergo induction or can be managed expectantly. At 41weeks of gestation the perinatal mortality rate is 9 per 1000 live births, and it continues to rise thereafter. Labour induction at 41 weeks gestation for otherwise uncomplicated singleton pregnancies reduces caesarean delivery rates without compromising perinatal outcomes. Study Design: 200 Low risk primigravida at 40 weeks of gestation were included and randomized into two groups. Group I=Induction group (n=100) Patients were admitted at 40 weeks and were induced at 40+0 to 40+6 Weeks. Patients in Group II the Expectant group which was further subdivided into 2 groups. Group IIa=Those who went into labour or had PROM or any omnious event during the Expectant period till 41weeks. Group IIb=Patients who reached 41weeks and then were induced. Results: Expectant management till 41weeks and then inducing labour at 41weeks resulted in a significantly higher number of patients having vaginal delivery when compared with patients who were induced at 40weeks. The incidence of meconium stained liquor, caesarean section, non-reassuring CTG, maternal complications and neonatal morbidity was high in Group I when compared to Group II. Conclusion: Labour induction in uncomplicated pregnancies at 41 weeks is not associated with increased rates of operative delivery, maternal and neonatal morbidity. Keywords: Expectant management, Labor induction, Post term pregnancy.