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Prolonged pregnancy: the management debate.

L Cardozo, J Fysh, J M Pearce

    British Medical Journal (Clinical Research Ed.)
    |October 25, 1986
    PubMed
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    Routine induction of labor at 42 weeks

    Area of Science:

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

    Background:

    • Prolonged pregnancy, defined as gestation beyond 42 weeks, is common.
    • Routine induction of labor is a common intervention for prolonged pregnancies.
    • Evidence comparing conservative management with routine induction is needed.

    Purpose of the Study:

    • To compare the effects of conservative management versus routine induction of labor at 42 weeks' gestation.
    • To evaluate maternal and neonatal outcomes in uncomplicated prolonged pregnancies.
    • To determine if routine induction of labor is beneficial for prolonged pregnancies.

    Main Methods:

    • Prospective trial comparing conservative management with routine induction of labor.
    • 402 pregnancies studied, allocated to conservative (207) or active induction (195) groups.

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  • Outcomes assessed included labor progression, interventions, Apgar scores, and umbilical cord pH.
  • Main Results:

    • No significant difference in labor stages or mode of delivery between groups.
    • Trend towards increased fetal distress interventions in the active induction group (p<0.06).
    • Higher rate of neonatal intubation (15% vs 8%) and lower umbilical cord pH in the active induction group.

    Conclusions:

    • No evidence supports routine induction of labor at 42 weeks for normal prolonged pregnancies.
    • Conservative management appears safe and effective for uncomplicated prolonged pregnancies.
    • Planned induction of labor may be associated with increased neonatal interventions.