Feto-maternal outcome in pregnancy beyond 40 weeks

Paras V. Dobariya; Parul T. Shah; Hina K. Ganatra

doi:10.18203/2320-1770.ijrcog20170375

Authors

Paras V. Dobariya Department of Obstetrics and Gynecology, VS General Hospital, Ahmadabad, Gujarat, India
Parul T. Shah Department of Obstetrics and Gynecology, VS General Hospital, Ahmadabad, Gujarat, India
Hina K. Ganatra Department of Obstetrics and Gynecology, VS General Hospital, Ahmadabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170375

Keywords:

Induction of labour, Prolonged pregnancy, Perinatal morbidity, Ultrasound

Abstract

Background: Fetal, Neonatal and Maternal complications associated with pregnancy beyond 40 weeks have always been underestimated. However emerging evidence demonstrates that the incidence of complications increases after 40 weeks of gestation. The present study conducted to find out the fetomaternal outcome of such prolonged pregnancy.

Methods: A prospective cross sectional study of 84 patients with uncomplicated prolonged pregnancy fulfilling the inclusion and exclusion criteria and admitted in department of obstetrics and gynecology at a tertiary care hospital. The aim of the study was to know fetomaternal outcome in pregnancy beyond 40 weeks in consideration of spontaneous and induced labour.

Results: Out of 84 patients, 58 (69.05%) were in the age group of 20-30 years, 44 (52.38%) were between 41-42 weeks of gestation according to their LMP and 38(45.24%) were between 40-41 weeks of gestation. In 27 (32.14%) patients mode of delivery was caesarean section, in whom most common indication being fetal distress in 48.15% followed by failure to progress in 22.22%. In present study perinatal morbidity like IUFD, neonatal asphyxia, MAS, RDS were 4.76%, 9.52%, 7.14% and 3.57% respectively. Maternal morbidity like prolonged labor, PPH, fever, wound infection were 10.71%, 5.95%, 3.57% and 3.57% respectively.

Conclusions: With Regular antenatal check-up, incidence of postdate pregnancy can be decreased and it is important because of definite risk to fetus as pregnancy continuing beyond 40 weeks of gestation is associated with increased perinatal morbidity and mortality especially those who do not come for regular antenatal check-up. Confirmation of diagnosis of exact term of pregnancy is very important as many patients don’t have regular menstrual history and LMP. Diagnosis can be confirmed by first trimester ultrasound which is most important non-invasive method and readily available.

Metrics

Metrics Loading ...

References

World health organization. ICD-10: international statistical classification of diseases and related health problems, 10th revision. Volume 2. 2nd ed. Geneva: WHO;2004.

Spong CY. Defining “term” pregnancy: recommendations from the defining “Term” pregnancy workgroup. JAMA. 2013;309:2445-6.

Reddy UM, Bettegowda VR, Dias T, Yamada-kushnir T, Ko CW, Willinger M. Term pregnancy: a period of heterogenous risk for infant mortality. Obstet Gynecol. 2011;117:1279-87.

Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. Eunice kennedy shriver NICHD maternal-fetal medicine units network. N Engl J Med. 2009;360:111-20.

Taipale P, Hiilesmaa V. Predicting delivery date by ultrasound and last menstrual period in early gestation.Obstet Gynecol. 2001;97(2):189-94.

Savitz DA, Terry JW Jr, Dole N. Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. Am J Obstet Gynecol. 2002 Dec. 187(6):1660-6.

Divon MY, Ferber A, Nisell H, et al. Male gender predisposes to prolongation of pregnancy. Am J Obstet Gynecol. 2002;187(4):1081-3.

Usha Kiran TS, Hemmadi S, Bethel J, et al. Outcome of pregnancy in a woman with an increased body mass index. BJOG. 2005;112(6):768-72

Caughey AB, Washington AE, Laros RK Jr. Neonatal complications of term pregnancy: rates by gestational age increase in a continuous, not threshold, fashion. Am J Obstet Gynecol. 2005;192(1):185-90.

Heimstad R, Romundstad PR, Salvesen KA. Induction of labour for post-term pregnancy and risk estimates for intrauterine and perinatal death. Acta Obstet Gynecol Scand. 2008;87(2):247-9.

Caughey AB, Stotland NE, Washington AE. Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol. 2007;196(2):155.e1-6.

Caughey AB, Nicholson JM, Cheng YW, et al. Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol. 2006;195(3):700-5.

William’s Obstetrics. Antepartum assessment, ed 21, Pg. 1107. 2010.

Bishop EH. Pelvis scoring for elective induction. Obstet Gynecol. 1964;24(2):266-8.

Baskett TF, Nagele F. Naegele’s rule: a reappraisal. BJOG. 2000;107(11):1433-5.

Foetal monitoring in practice: Clinical assessment and practice; Donald Gibb, 11ed, 2000:2-3.

O’ Brien WF. Cervical ripening and labour induction. Forword. Clin Obstet Gynecol. 1995;38:219-23.

Singal P, Sharma A. Fetomaternal outcome following postdate pregnancy – a prospective study. J Obst Gynecol Ind. 2001;51(5):89-93.

Alexander JM, Macer CL. Elective induction versus spontaneous labor: A prospective study of complications and outcome. Am J Obstet Gynecol. 1992;166:1690-7.

Heimstad R, Romundstad PR, Eik-Nes SH, Salvesen KA. Outcomes of pregnancy beyond 40 weeks of gestation. Obstet Gynecol. 2006;108:500-8.