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Related Experiment Videos

Prolonged pregnancy: the management dilemma.

Y Herabutya1, P O Prasertsawat, T Tongyai

  • 1Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|April 1, 1992
PubMed
Summary

Inducing labor with prostaglandin gel after 42 weeks of gestation showed no significant difference in outcomes compared to expectant management. Post-term pregnancies managed with induction or expectant care had similar results, with fewer non-induced infants needing intubation.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatal Research

Background:

  • Post-term pregnancies, defined as those extending beyond 42 completed weeks of gestation, require careful management to ensure optimal maternal and neonatal outcomes.
  • Unfavorable cervical conditions in post-term pregnancies present a clinical challenge, necessitating evaluation of different management strategies.

Purpose of the Study:

  • To compare the efficacy and safety of antepartum fetal testing versus prostaglandin gel induction of labor in pregnancies at or beyond 42 weeks with an unfavorable cervix.
  • To determine if expectant management beyond 42 weeks offers advantages over labor induction in this specific obstetric population.

Main Methods:

  • A prospective randomized study involving 108 pregnancies at least 42 weeks gestation with unfavorable cervix.

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  • Participants were randomized to either antepartum fetal testing or prostaglandin gel induction of labor.
  • Outcomes assessed included meconium staining, fetal distress, labor duration, need for intervention, mode of delivery, Apgar scores, and neonatal intubation rates.

    • Main Results:

    • No significant differences were observed between the induction and non-induction groups regarding meconium staining, fetal distress, labor duration, need for intervention, or delivery mode.
    • Neonatal outcomes, assessed by Apgar scores, were not significantly different between groups.
    • A higher proportion of infants in the non-induced group (7.8%) required intubation compared to the induced group (1.8%).

    Conclusions:

    • Induction of labor with prostaglandin gel for post-term pregnancies (≥42 weeks) with an unfavorable cervix does not appear to confer significant disadvantages compared to expectant management.
    • Allowing pregnancies to continue beyond 42 weeks without intervention does not offer a clear advantage and may be associated with a slightly increased need for neonatal intubation.
    • Prostaglandin gel induction is a viable option for managing post-term pregnancies when intervention is deemed necessary.