Abstract
Introduction. Post-term delivery is associated with significantly increased risks of perinatal and maternal complications. The aim of the study was to compare maternal and neonatal complications in two groups: women who delivered at 41 completed weeks (study group) and women who delivered at 40 completed weeks (control group). Materials and methods. This is a retrospective case-control study which included all pregnant women who delivered in the Vilnius City University Hospital (VCUH) from January 1, 2007 to December 31, 2007. Patients were eligible for inclusion in our study if they delivered a live birth beyond 41 weeks of gestation during the study period in the VCUH (n = 182). Using the week of gestation as the primary predictor variable, we examined its association with the following outcomes: mode of delivery, expectant management or labour induction, labour induction method, delivery time, perineal laceration, postpartum hemorrhage, meconium-stained amniotic fluid, oligohydramnios, umbilical artery pH, neonatal morbidity, duration of hospitalisation. From all the women who delivered from 40 completed weeks to 40 weeks + 6 days (n = 193) in the same study period, every tenth woman was selected for the control group. Results. The pregnancy protracts frequently for nulliparous women without reference to mother’s age. Labour induction in them more frequently occurs at 41 completed weeks than in the control group (39.6% vs 14.5%, p < 0.05; OR 0.37), and the main way of induction in prolonged pregnancies is vaginal prostaglandins. The mother and her newborn at 41 completed weeks tend to have a higher risk of oligohydramnios (10.4% vs 5.2%, p < 0.05; OR 0.5), umbilical cord rotation around the baby’s neck (57% vs 43%, p < 0.05; OR 0.7), meconium-stained amniotic fluid (27.4% vs 16.6 %, p < 0.05; OR 0.6), vacuum extraction rate (7.7% vs 3.1%, p < 0.05; OR 0.4), newborn acidosis (45.5 % vs 33.2%, p < 0.05; OR 0.73). When meconium-stained amniotic fluid is diagnosed at 41 completed weeks, the delivery should be monitored more intensively because of a higher risk of newborn acidosis after the labour. The mode of delivery, delivery duration, mother’s injuries, postpartum hemorrhage and complications, also Apgar scores show no significant differences in these groups. Conclusion. When delivery occurs at 41 competed weeks, the results are worse as compared to those of the delivery at 40 completed weeks. Therefore, it is reasonable to induce labour at 40 completed weeks and beyond of gestation. This suggestion requires large prospective studies and a very precise gestation time estimation for all pregnant women before recommending labour induction at 40 competed weeks. Keywords: gestational age, post-term pregnancy, caesarean delivery, labour induction, expectant management, meconium-stained amniotic fluid
Highlights
Post-term delivery is associated with significantly increased risks of perinatal and maternal complications
After labour induction caesarean sections were more frequent in the group of 41 completed weeks (SG – 16 cases, 22%; CG – 3 cases, 10%; p < 0.05; OR 2.3)
Our study is in concordance with these statements – we found a higher risk of oligohydramnios, umbilical cord rotation around the baby’s neck, meconium presence in amniotic fluid, vacuum extraction rate, newborn acidosis at 41 weeks of gestation and beyond
Summary
Post-term delivery is associated with significantly increased risks of perinatal and maternal complications. A policy of labour induction after 41 completed weeks or later, compared to awaiting spontaneous labour for at least one week (42 completed weeks), is associated with fewer perinatal deaths and meconium aspiration syndrome, without an increased risk of caesarean section (A) [9, 11]. Randomized, controlled trials suggest that elective induction of labour at 41 weeks of gestation and beyond is associated with a decreased risk for cesarean delivery and meconium-stained amniotic fluid [12]. Among women with less than 41 weeks of gestation, there were trials which reported no difference in the risk of cesarean delivery among women who were induced as compared to expectant management. When the data were stratified by country, the odds of caesarean delivery were higher in women who were expectantly managed compared to elective induction of labour in studies conducted outside the USA [13]
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