The Comparison of Perinatal Outcomes in Early Delivery Versus Postdate Labor

Abstract

Background: Prenatal mortality and morbidity increase after 40 weeks of gestation. The current study aimed at comparing maternal and neonatal outcomes between term and postterm pregnancies. Methods: The current prospective cohort study was performed on 1180 singleton, cephalic fetus, and uncomplicated pregnancy cases admitted for labor. Pregnant mothers were divided into 3 groups. Group 1 included 750 cases in 38 to 40 weeks, group 2 included 250 cases in 40 to 41 weeks, and group 3 included 180 cases in over 41 weeks of gestation. Prenatal outcomes were recorded as: fetal distress, meconium passage, meconium aspiration, fetal weight ≥ 4 kg, Apgar score in 1 and 5 minutes, neonatal intensive care unit (NICU) admission, maternal infection, postpartum hemorrhage, and the rate of cesarean section. Results: There were significant differences in the rate of fetal distress (P < 0.001), meconium passage (P = 0.001), meconium aspiration syndrome (P < 0.001), Apgar score ≤ 3 at 1 (P = 0.025) and 5 minutes (P < 0.001), admission to NICU (P < 0.001), rate of cesarean section (P < 0.001), and maternal infection (P = 0.001) among the groups. The frequency of fetal distress was lower in group1 compared with group 2 (1.6% versus 4.4%; P = 0.011). Also fetal distress was significantly lower in group 1 than group 3 (1.6% versus 10.9%; P < 0.001). The meconium passage and meconium aspiration syndrome were statistically lower in group 1 compared with group 2 (1.6% versus 8%; P < 0.001 for meconium passage, and 0.9% versus 5.6%; P < 0.001 for meconium aspiration syndrome). Also meconium passage and meconium aspiration syndrome were significantly lower in group 1 compared with group 3 (1.6% versus 13.9%; P < 0.001 for meconium passage, and 0.9% versus 10%; P < 0.001 for meconium aspiration syndrome). The cesarean section was more frequent in group 2 compared with group 1 (24.8% versus 13.6%; P < 0.001) and in group 3 compared with group 1 (33.3% versus 13.6%, P < 0.001). There was no significant difference in the mean fetal weight, fetal weight ≥ 4 kg, and postpartum hemorrhage in females between the 3 groups. Conclusions: Late-term and postterm births are associated with higher rates of fetal and neonatal morbidity and maternal risks compared to pregnancy termination before 40 weeks of gestation, and earlier birth induction is recommended in such cases.

Developing and validating the Caesarean risk assessment nomogram and comparing the effect of cervical ripening balloon, evening primrose oil and misoprostol on childbirth outcomes in term pregnancies: A study protocol

“…For this reason, many physicians today perform labour induction in 41‐week low‐risk pregnancies. They believe that induction of labour in such cases is a therapeutic policy to reduce the mortality and prevent increasing maternal complications (Bleicher et al., 2017 ; Jochum et al., 2019 ; Khooshideh et al., 2017 ). Meanwhile, determining the Caesarean delivery risk following labour induction is an important measure to reduce the emergency complications of unsuccessful induction.…”

“…Many clinical trials and meta-analyses support the idea that in comparison with expectant management, labour induction after 41 weeks is associated with a significant reduction in perinatal mortality, meconium aspiration and Caesarean delivery (Khan et al, 2006;Maoz et al, 2019;Mozurkewich et al, 2009). A successful induction depends on several factors, in particular the Bishop score which assesses the dilatation, effacement, consistency and position of the cervix and the station of foetal presenting part (Khooshideh et al, 2017;Vitner et al, 2020). A high Bishop score (≥6) is correlated with a successful labour induction and vaginal delivery, and a low Bishop score (<6) is correlated with high rates of failed induction and Caesarean delivery (Navve et al, 2017).…”

Development and Validation of a Nomogram to Estimate Risk of Cesarean After Induction of Labor in Term Pregnancies with an Unfavorable Cervix in Iran

“…Labor induction begins at 41 weeks in post-term pregnancies, according to national protocol (Khooshideh et al, 2017; Weiss et al, 2014). After 40 weeks, more than 40% of pregnant women give birth, and roughly 15% to 20% after 41 weeks.…”