COMPARATIVE STUDY OF MATERNAL AND NEONATAL OUTCOMES OF LABOUR INDUCTION AT 40 WEEKS VERSUS EXPECTANT MANAGEMENT FROM 40 WEEKS TILL 40 WEEKS 6 DAYS IN TERM NULLIPAROUS WOMEN

Abstract

Background:The goal of obstetrics is a pregnancy that results in a healthy infant and a healthy mother.Much of the art of good obstetric care involves the delicate balance of avoiding caesarean delivery with all its attendant complications Methods :A Prospective randomized control study conducted at PESIMSR, KUPPAM, Comparing maternal and neonatal outcomes of labour induction at 40 weeks versus expectant management from 40 weeks till 40 weeks 6 days in term nulliparous women. The study protocol was approved by the institutional ethics board.Written informed consent was obtained from all study subjects. The women were categorized into group A and group B by computer-generated randomization each containing 64 nulliparous pregnant women. The primary outcome was maternal and neonatal outcomes in nulliparous women with labour induction at 40 weeks versus expectant management at 40 weeks till 40 weeks 6 days. Results: 128 nulliparous pregnant women who met the inclusion criteria was taken into the study after obtaining consent.The mean age of patients in induction group was 23.12 +/- 2.805 and in expectant group was 22.62 +/- 2.547 years.The mean period of gestation in expectant group was 40 weeks 4 days.42.19% of participants in group A had a cesarean section, 1.56% had instrumental delivery and 56.25% had a normal vaginal delivery.Where as in group B, 23.43% had a cesarean section,3.13% had instrumental delivery,and 73.44% had a normal vaginal delivery.There was no statistical significance between the mode of delivery in Group A and Group B (p=0.074).A longer duration of labour was noted in induction group compared to expectant group. P value 0.043, which is statistically significant. NICU admissions were high in an expectantly managed group compared to the induction group.But when APGAR scores were compared in both groups,no statistical significance was seen at 1 minute and 5 minutes.Conclusion:Labor induction at 40 weeks appears to be a safe alternative to expectant management for spontaneous labor beyond 40 weeks to deliver with no mortality and minimum morbidity to safeguard the mother and neonate,with precautions and evidence-based protocols to identify the risks and challenges to initiate the natural labor process.