EFFECT OF INTERVENTION IN LATE AND POST TERM PREGNANCIES ON NEONATAL AND EMPLOYED WOMEN OUTCOMES

Abstract

Background: A prolonged pregnancy is a pregnancy between 41+ 0 weeks through 41+6 weeks of gestation. It is also known as late–term pregnancy measured from the first day of the last menstrual period. It is approximately 5 to 10 percent of all pregnancies. The pregnancy which continued beyond 42 weeks' gestation is called post term or post maturity pregnancy. It is about 1%. Postterm pregnancy is associated with higher risk of maternal and fetal complications such as emergency cesarean delivery, postpartum hemorrhage, birth canal injuries, macrosomia, meconium aspiration syndrome, and admission to neonatal intensive care unit (NICU). Objective: To determine the effects of induction of labor in late and post term pregnancies on mode of deliveries, to determine the risk of obstetrical and fetal complications in prolonged pregnancy in employed women, to compare the maternal and neonatal outcomes between induction of labor group and expectant management group, and to detect prenatal risk indicators of prolonged pregnancy in employed women. Subjects and Methods: Across sectional descriptive study of selected data included deliveries of late and post term pregnancies at Misurata Medical Center from the 1st of January to 30th of June 2018 where 188 patients were included in the study. Women with gestational age between 41+0 to 42+6 completed weeks and beyond were included in the study. A comparison between expectant management and induction of labor management was conducted to evaluate maternal, fetal and neonatal complications. Results: The rate of cesarean deliveries was a significantly higher for induction of labor (IOL) group (26%) compared with expectant management group (9.6%). Besides, the more frequent occurrence of all types of perineal lacerations and episiotomies (51% in IOL group vs 16% in expectant management group) in women with vaginal deliveries. The total number of deliveries was 2248, the full term deliveries were 1890 (84%), preterm deliveries were 170 (7.6%), late and post term deliveries were 174 and 14 (7.7% and 0.8%) respectively. Cesarean deliveries in women with prolonged pregnancies 33 patients (17.6%); 4.8% were elective LSCS due to previous uterine scar and prolonged pregnancies and 12.8% were emergency LSCS because of pathological cardio-tocography (CTG), failed IOL and maternal exhaustion. Postterm case, about 24% of cases had previous history of prolonged pregnancy, 20% with family history of prolonged pregnancy. 15% of cases were primigravida, 51.6% were between P1-P3, and 33% were more than P3. In present study, neonatal outcome 98.9% were normal Apgar and 1.06% were with low Apgar less than 7 at five minutes. Thirty six neonates (19%) were admitted to neonatal ICU, for observation and supportive management because of transient tachypnea 1-2 days after operative deliveries and discharge with good state.Regarding birth weights of neonates among women in IOL group and who had spontaneous onset labor (84%)ranging from2500 grams (g) - 4000 g, only(2.7%) were large infants more than 4000 g. Conclusion: Induction of labor in late and postterm pregnancies was associated with increasing the rate of cesarean delivery. However, other maternal and fetal parameters were not affected by IOL.