Finalización electiva versus manejo expectante en el control de la gestación prolongada: estudio prospectivo de 200 gestantes

Abstract

Objective To compare elective termination versus expectant management in low-risk prolonged pregnancy. Material and method We performed a controlled randomized clinical trial comparing the results of active and expectant approaches in the management of low-risk prolonged pregnancy in a sample of 200 women between February 2003 and June 2005 at the Maternity Ward of the Canary Islands University Hospital. Results The study group consisted of 200 patients. There were 102 in the active management group and 98 in the expectant management group. No between-group epidemiologic differences were found. Labor was not induced in a significantly higher proportion of patients in the active than in the expectant group [51% vs 35.7%, p = 0.02; OR 0.53 (95% CI 0.3-0.94)] i.e. the induction rate was significantly higher in the expectant group. The proportion of patients with meconium-stained amniotic fluid during labor was significantly lower in the active management group [15.7% vs 28.6% p = 0.02; OR 0.47 (95% CI 0.23-0.93)]. No significant differences were found in the type of delivery, although the proportion of cesarean sections was noticeably lower in the active management than in the expectant management group [(12.7% vs 18.4%, p = 0.3; OR 0.65 (95% CI 0.3-1.41)]. No significant differences were found in perinatal outcomes between the two groups. Conclusions Elective termination of low-risk pregnancies with unfavorable cervical findings at week 42 seems to reduce the rate of cesarean section without impairing perinatal outcome.