Maternal and Fetal Outcome in Pregnancy Beyond the Expected Date of Delivery in a Tertiary Care Hospital of Nepal

Abstract

Background: The risk to the mother and the fetus increase with advancing gestation age. Our study aims to study the maternal and fetal outcome in pregnancy extending beyond the expected date of delivery so that safe timings of induction and appropriate mode of delivery can be determined. Methods: We conducted a retrospective study of 152 patients with pregnancy beyond the expected date who presented to the department of Obstetrics and Gynecology, College of Medical Sciences Teaching Hospital from the time period of October 2019- November 2021.The primary outcome measures were obtained in terms of rate of cesarean section, postpartum hemorrhage, wound infection, admission in neonatal intensive care unit, birth asphyxia and meconium aspiration syndrome. Statistical analysis was performed using Chi-square test with P value <0.05. Results: The majority of 86 (56.58%) patients were between 40-41 weeks of gestation. Maximum number of vaginal deliveries were seen between 40-41weeks (77.90%). Overall cesarean section rate was 40.13% with maximum number between 41-42 weeks (64.28%). Fetal distress with meconium-stained liquor was the most common indication (36.06%). The rate of neonatal intensive care unit admission was 16.44% with birth asphyxia (12.50%) and meconium aspiration syndrome (8.55%) as the primary cause for admission. Maternal complications like oligohydramnios, postpartum hemorrhage, wound infection, cervical tear, shoulder dystocia was seen in 16.45%, 1.97%, 1.97%, 2.63% and 1.31% respectively. Conclusions: The pregnancy beyond the expected date causes definite risk to the mother and the fetus. Therefore, strict fetal surveillance with early induction of labor prior to expected date of delivery is recommended for better fetomaternal outcomes.

Maternal and fetal outcomes of pregnancies beyond 40 weeks of gestation at a tertiary care hospital in Port Harcourt, Nigeria

“…Nulliparity is a recognized risk factor for postdate pregnancy [1] and various studies have reported incidence of 55.7% [10] , 63% [26] , and 74% [28] among primigravida. In contrast, this study found a higher prevalence among multiparous women, similar to reports of 53.29% and 54% by Chhetri et al [31] and Naz et al [34] . The higher occurrence among nulliparous women has been suggested to be likely due to inaccuracies in recollecting the exact date of last normal menstrual period, especially when the pregnancy is unplanned [10] and particularly where pregnancy dating was done by last menstrual period alone [35] .…”

“…There was a decreased rate of spontaneous vaginal delivery and increased rate of CD as the gestational age advanced. This finding has been corroborated by studies by Chhetri et al [31] , Bhriegu et al [38] , and Reddy [39] . While the study by Chhetri et al [31] reported the highest proportion of CD (64.28%) in women between 41-42 weeks, we found a proportion of 49.4% at 41 weeks, rising to 77.8% in those ≥42 weeks.…”

“…This finding has been corroborated by studies by Chhetri et al [31] , Bhriegu et al [38] , and Reddy [39] . While the study by Chhetri et al [31] reported the highest proportion of CD (64.28%) in women between 41-42 weeks, we found a proportion of 49.4% at 41 weeks, rising to 77.8% in those ≥42 weeks. The most common indications for CD in this study were CPD in 53.1% and fetal distress in 31.2%.…”

“…Postdate pregnancies are associated with higher rates of intervention, and many studies have reported high CD rates. Onyebuchi et al [10] reported a 25% CD and 1.1% IVD rates, Singh N et al [36] reported CD and IVD rates of 32% and 2% respectively, Chhetri et al [31] reported 40.13% and 2% for CD and IVD respectively, while a study by Singh S, et al [37] reported an even higher CD rate of 56.5%. The variations in the CD rates may be attributed to practice guidelines/protocols in the various centers, and the threshold for performing caesarean sections in labouring women.…”

“…Other studies with similar categorization of maternal age group of 20-30 years have reported 85% [28] , 69% [29] , and 64% [30] . Some other studies used the age category of 20-35 years and reported 89.4% [31] , 85.3% [32] , and 80.2% [33] . Nulliparity is a recognized risk factor for postdate pregnancy [1] and various studies have reported incidence of 55.7% [10] , 63% [26] , and 74% [28] among primigravida.…”