Active management of prolonged pregnancy

Area of Science:

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

Background:

• Prolonged pregnancies (gestation >= 294 days) present increased risks for perinatal morbidity and mortality.
• The management of prolonged pregnancies, including labor induction versus spontaneous onset, requires careful consideration of outcomes.

Purpose of the Study:

• To assess perinatal morbidity and mortality in prolonged pregnancies compared to term gestations.
• To evaluate the impact of labor induction versus spontaneous labor onset on perinatal outcomes in prolonged pregnancies.

Main Methods:

• Observational study of consecutive deliveries at Chicago Lying-In Hospital (July 1980 - December 1984).
• Comparison of perinatal outcomes, complications, and labor characteristics between prolonged gestations and term gestations.
• Analysis of spontaneous labor onset versus induced labor ('active management') in prolonged pregnancies using chi-squared analysis.

Main Results:

• Prolonged gestations (5.5% of deliveries) had significantly higher perinatal mortality (14/1000) than the general population.
• Induction of labor in prolonged gestations was associated with less meconium presence (23% vs. 40%) and fewer depressed neonates (p=0.03) compared to spontaneous onset.
• All observed perinatal deaths occurred in prolonged gestations with spontaneous labor onset; no deaths were recorded among induced labors in this group.

Conclusions:

• Prolonged gestation is a significant risk factor for perinatal morbidity and mortality.
• "Active management" through induction at 42 weeks in prolonged gestations prevented perinatal deaths.
• While induction increased the primary cesarean section rate compared to the general obstetric population, an active approach appears justified for prolonged gestations.