Management of prolonged pregnancy

Abstract

Objective: To compare two strategies for management of prolonged pregnancy (> or = 294 days) i.e. induction (intervention) versus expectant management (non-intervention) and evaluate the associated feto-maternal risks.

Design: A quasi experimental study.

Place and duration of study: Sobhraj Maternity Hospital, from September 2000 to September 2001.

Subjects and methods: One hundred cases of uncomplicated prolonged gestation were selected. The gestational age was confirmed by ultrasound in first trimester. One group (50 patients) was managed by intervention i.e. induction of labour (group A) and other group (50 patients) by non-intervention i.e. expectant management (group B). In group A intervention was done at 42 weeks. In expectant group, the methods of monitoring were fetal kick charting recorded daily by the patient, and ultrasound for amniotic fluid index. The bio-physical profile score and NST (non stress test) were performed once a week till 42 weeks and then twice weekly.

Results: The frequency of prolonged pregnancy was found to be 10.9%. There was no significant difference in the number of spontaneous vaginal deliveries between the two groups. The rate of LSCS (lower segment caesarean section) was higher in intervention group (30% versus 18%). The neonatal depression at birth was more in group B (10% versus 4%) and at 5 minutes almost same between two groups (4% versus 2%). There were 11 cases of meconium aspiration syndrome, leading to one neonatal death. Among nine perinatal deaths two were neonatal deaths. Seven cases of intrauterine deaths in which antepartum deaths occurred because of non compliance of patients. No cause could be detected for the other three fetuses.

Conclusion: There was increased LSCS rate in group A. However in expectant group B perinatal mortality was about twice more as compared to intervention group. Active early intervention at 42 weeks is warranted to reduce perinatal morbidity and mortality.