Maternal-fetal outcomes in prolonged pregnancy

Area of Science:

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

Background:

• Prolonged pregnancies (gestation > 42 weeks) present unique challenges for fetal well-being and delivery management.
• Continuous fetal monitoring is essential for identifying intrapartum risks in these high-risk pregnancies.
• Understanding outcomes in prolonged gestations is critical for optimizing obstetric interventions.

Purpose of the Study:

• To evaluate intrapartum fetal heart rate changes, labor characteristics, delivery modes, and neonatal outcomes in prolonged pregnancies.
• To assess the safety and efficacy of labor induction in pregnancies exceeding 42 weeks.
• To determine the incidence of adverse neonatal outcomes and identify risk factors in post-term infants.

Main Methods:

• Retrospective analysis of 379 consecutive continuously monitored prolonged pregnancies.
• Data collection included fetal heart rate patterns, labor management (induction/augmentation with oxytocin), delivery methods (cesarean, forceps), and neonatal assessments.
• Analysis of neonatal outcomes such as Apgar scores, hospital stay, and postmaturity syndrome incidence.

Main Results:

• High incidence of fetal heart rate alterations (FHRAs) observed in prolonged pregnancies.
• Cesarean section rate was 13% (9% in induced cases); 60% of C-sections were for cephalopelvic disproportion, with 13% of fetuses > 4000 gm.
• Neonatal depression occurred in 15% at 1 minute and 4% at 5 minutes; 19% experienced postmaturity syndrome.

Conclusions:

• Active labor induction in prolonged pregnancies is justified and does not appear to increase the cesarean section rate.
• High incidence of FHRAs underscores the need for vigilant monitoring and timely intervention.
• Induction is a valuable intervention to potentially prevent stillbirths and improve neonatal outcomes in post-term gestations.