Outcome In Post-term Pregnancies Research Articles

Measurement of Cerebro-Placental Doppler Ratio and Amniotic Fluid Index as a Predictor of Perinatal Outcome in Prolonged Pregnancy

Background: The terms post-term, prolonged, postdates and post mature are often loosely used interchangeably to signifypregnancies that have exceeded a duration considered to be the upper limit of normal.Objective: The aim of this work was to study the role of Doppler velocimetry of the umbilical and middle cerebral arteriesrepresented by the cerebroplacental ratio and amniotic fluid volume in the prediction of adverse fetal outcome in post-termpregnancies.Materials and Methods: This is a prospective case control study conducted at Ain-Shams University Teaching Hospitalfor Obstetrics and Gynecology, Egypt. The study included 50 pregnant patients who were divided into two groups; group1included 25 pregnant ladies with gestational age of 41 weeks attending the casuality department in labour or in prodromaof labor. while, group 2 included 25 pregnant ladies with gestational age of 41 weeks not in labor and reaching thehospital for ANC, who were selected for termination based on the biophysical profile and poor Doppler indices or CTGchanges. All patients were submitted to antenatal fetal surveillance tests including modified biophysical profile (MBPP)which consists of the non-stress test (NST), amniotic fluid index (AFI), and color Doppler velocimetry of fetoplacentaland fetal vessels including MCA PI, UA PI, and CPR. The accuracy of cerebroplacental ratios (the middle cerebral arteryPI divided by the umbilical artery PI) and amniotic fluid volume as a means of predicting intrauterine fetal distress andadverse perinatal outcome in post-term pregnancies.Results: Cerebroplacental ratio showed the highest sensitivity (95%) in comparison with other parameters, so it is a goodtest to reassure the obstetricians of the fetal well being. Prominent changes in AFI (i.e. 5.0 cm. Asignificant association with FHR decelerations and presence of meconium is proved to exist when AFI is <5.0 cm.Conclusion: The addition of cerebral/umbilical ratios to antenatal surveillance protocols is expected to improve the perinataloutcome. It should be tried in the various high risk pregnancies whenever uteroplacental insufficiency is suspected.

To Determine the Effects of Labor Induction on Maternal and Fetal Outcome in Postterm Pregnancies (41 Weeks Plus)

Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in 1000 live births in pregnancies of 37 weeks to 2.12 in 1000 live births in pregnancies of 43 weeks gestation. Morbidities associated with postterm births include an increased risk of fetal distress, intrauterine growth restriction, dysfunctional labor, shoulder dystocia, obstetric trauma (relative risk 1.09 - 1.68) and an increase in perinatal complications, such as aspiration of meconium and asphyxia, peripheral nerve injury, greenstick bone fractures, pneumonia and septicemia (adjusted odds ratio 1.4 - 2.0). Antenatal surveillance and induction of labor may decrease the risks of an adverse outcome. In a recent review of term and postterm pregnancies in Norway, we found that there were adverse outcomes associated with both postterm pregnancy and induction of labor independently. On comparison of the two, a randomized controlled trial showed no difference in their neonatal outcome, but demonstrated a reduction in the cesarean delivery rate when labor was induced at 41 weeks. Aim of the Work: The aim of this study was to determine the effect of labor induction on maternal and fetal outcome in postterm pregnancies. Subjects and Methods: This study was carried out on 150 pregnant women who had completed 41 weeks of gestation between Jun. 1, 2012 up to Dec. 31, 2012 at Department of Obstetrics & Gynecology, Faculty of Medicine, Benghazi University, and were scheduled for induction of labor after cardiotocography (CTG) and ultrasonography (USS) have been done and Bishop’s score assessed, to determine the effects of labor induction on maternal and fetal outcome in postterm pregnancies (41 weeks plus). Results: Regarding the relationship between a history of (H/O) postdatism and fetal distress, it was found that there was no significant relationship between them. There was a significant relationship between a history of macrosomia and fetal distress. There was a significant relationship between instrumental delivery and fetal distress. The majority of the fetal distress had an indication for Caesarean section (CS) (fetal distress (FD) and fetal distress meconium (FDM) more than those without fetal distress. All fetuses that had APGAR scores of 8 were distressed. There was a significant relationship between the APGAR score at 10 minutes with fetal distress. All fetuses that had meconium aspiration had fetal distress. There was a significant increase in the amount of oxytocin in unit in distressed cases than the non-distressed ones. The total duration of induction was also significantly increased in stressed fetuses than the non-stressed ones. There was a significant increase in the weight of distressed fetuses than the non-distressed. Conclusions: In conclusion, there was no difference in the neonatal outcome or mode of delivery for postterm pregnancies managed either by immediate induction of labor or expectantly with serial antenatal surveillance. The outcomes were generally good, and neonatal morbidity, cesarean section, and operative vaginal delivery rates were low. If pregnancy is uncomplicated and continued surveillance is possible, women’s own wishes may guide the decision to induce or monitor a pregnancy beyond 41 weeks.

Les mesures échographiques de la longueur cervicale et de la hauteur de la présentation fœtale sont-elles prédictives de l’issue d’accouchement chez des patientes à terme ?

ObjectivePost-term pregnancy is frequently associated with higher fetal and maternal morbidity and mortality. Its management essentially depends on clinical cervical characteristics as evaluated by the Bishop score (BS). However, BS is poorly predictive of the delivery outcome. We sought to demonstrate that ultrasound measurement of cervical length and evaluation of fetal height could predict the outcome in post-term pregnancies. MethodsA prospective single center study was undertaken between the 21st of January and the 1st of June 2013. Fetal height was measured using a transperineal technique and cervical length was evaluated by a vaginal ultrasound on patients consulting and their term date. C-section rates were considered to be the primary judgment criteria. ResultsA total of 136 patients were included. C-section rates in this population was 19%. Fetal height and cervical length were not different between the C-section group and the vaginal delivery group. ConclusionOur study demonstrates that ultrasound measurement of cervical length and fetal height do not show better results than BS in predicting the outcome of post-term pregnancy. Combining these ultrasound measurements has already been suggested in other studies and promising results have been shown. More studies are necessary to further these results.

Recurrence rate and outcome of postterm pregnancy, a national cohort study

ObjectiveTo assess the recurrence rate of postterm delivery (gestational age at or beyond 42+0 weeks or 294 days) and to describe maternal and perinatal outcomes after previous postterm delivery. Study designFrom the longitudinal linked Netherlands Perinatal Registry database, we selected all singleton primiparous women who delivered between 37+0 and 42+6 weeks with a subsequent singleton pregnancy from 1999 to 2007. We excluded congenital abnormalities. We compared the recurrence rate of postterm delivery and risk of antenatal fetal death in women with and without a postterm delivery in their first pregnancy. We compared perinatal outcome (composite of perinatal mortality, Apgar score <7 and birth injury) and adverse maternal outcome (composite of maternal death, abruptio placentae, PPH>1000ml and blood transfusions) between women with a recurrent and a de novo postterm second pregnancy. ResultsOur study population consisted of 233,327 women of whom 17,874 (7.7%) delivered postterm in the first pregnancy. In the second pregnancy, 2678 (15%) women had a recurrent postterm delivery compared to 8698 (4%) women with a de novo postterm delivery (odds ratio (OR) 4.2 95% confidence interval (CI) 4.0–4.4). Subgroup analysis in recurrent and de novo postterm delivery showed no differences in composite perinatal and composite maternal outcome (OR 1.0; CI 0.7–1.5, p=0.90 and OR 1.1, CI 0.9–1.4, p=0.16), adjusted for fetal position and mode of delivery). ConclusionsWomen with a postterm delivery in the first pregnancy have a higher risk of recurrent postterm delivery. Our data suggest that there is no difference in the composite adverse perinatal outcome between recurrent and de novo postterm delivery.

Uncomplicated baseline fetal tachycardia or bradycardia in postterm pregnancies and perinatal outcome.

to assess perinatal outcome in post-term pregnancies in which fetal heart rate (FHR) monitoring revealed either uncomplicated baseline fetal tachycardia (> or = 160 bpm) or fetal bradycardia (< or = 120 bpm). We performed a case-control study of patients who underwent fetal assessment between July 1989 and June 1995, as part of post-term evaluation. Inclusion criteria consisted of nonlaboring afebrile patients with singleton post-term pregnancies > or = 41 weeks of gestation by strict dating criteria (last menstrual period consistent with ultrasound biometric parameters obtained prior to 20 weeks' gestation), normal fetal anatomy, intact membranes, and reactive nonstress test with no evidence of chorioamnionitis. Patients with fetal tachy or brady arrhythmias, FHR decelerations, or loss of short-term beat-to-beat variability were excluded. Baseline FHR was recorded retrospectively by an observer blinded to maternal and neonatal clinical outcome. For each case of uncomplicated baseline fetal tachycardia (> or = 160 bpm) or bradycardia (< or = 120 bpm), either two or three control cases (matched for maternal age and parity), with FHR > 120 bpm and < 160 bpm, were identified. Outcome variables assessed included: incidence of cesarean delivery, nuchal cord at delivery, meconium-stained amniotic fluid (AF), 5-min Apgar score < 7, fetal growth restriction (< 10th percentile for 41 weeks' gestation), meconium aspiration syndrome, and neonatal intensive care unit (NICU) admission. Statistical analysis included two-tailed t-test and chi2 test when appropriate, with p < 0.05 considered significant throughout. During the study period 1390 post-term patients (6.81% of the general population) were assessed. Of these, 31 (2.23%) fetuses exhibited baseline FHR > or = 160 bpm, and 76 fetuses (5.46%) exhibited baseline FHR < or = 120 bpm. No significant differences were noted in the incidence of cesarean delivery, presence of nuchal cord at delivery, meconium-stained AF, 5-min Apgar scores < 7, fetal growth restriction, meconium aspiration syndrome, or the incidence of NICU admissions between the groups of patients with fetal tachycardia, bradycardia, and their respective controls. Uncomplicated baseline fetal tachycardia or bradycardia in postterm patients are not associated with an increase in the incidence of adverse perinatal outcome.

Longitudinal measurement of amniotic fluid index in postterm pregnancies and its association with fetal outcome

OBJECTIVE: Our purpose was to study the association between dynamic changes in serial amniotic fluid index measurements and adverse fetal outcome in postterm pregnancies. STUDY DESIGN: Serial amniotic fluid index values were obtained semiweekly in 139 reliably dated, uncomplicated, singleton pregnancies at >41 weeks' gestation. Adverse fetal outcome was defined by the presence of moderate or thick meconium, fetal heart rate decelerations, cesarean delivery for fetal distress, neonatal intensive care unit admission, and perinatal mortality. RESULTS: Prominent changes in the amniotic fluid index (i.e., >50% increase or decrease) had no association with adverse fetal outcome irrespective of rate of change, provided the final value remained >5.0 cm. A significant association with fetal heart rate decelerations and the presence of meconium was detected only in patients whose final amniotic fluid index was ≤5.0 cm ( p = 0.007 and p = 0.003, respectively). CONCLUSION: Irrespective of the rate of change in amniotic fluid index, postterm pregnancies are significantly associated with potential complications such as fetal heart rate decelerations and meconium staining when the final amniotic fluid index is ≤5.0 cm.