S1-Guideline: Management of Late-term and Post-term Pregnancy

Weiss, Elliott Mark; Abele, Harald; Bartz, C.; Franz, Marie; Fischer, Thorsten; Gembruch, Ulrich; Gonser, M.; Heim, K; Kainer, Franz; Kiefer, Anna M; König, Klaus; Ramsauer, B.; Reister, Frank; Schneider, K. T. M.; Surbek, Daniel; Vetter, K.; Wolff, F.

doi:10.1055/s-0034-1383314

Cited by 10 publications

(7 citation statements)

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“…Pregnant women beyond 40 + 0 weeks of gestation form a rather large and sensitive group. According to the American College of Obstetricians and Gynecologists 2014 [16] the likelihood for placental insufficiency is even higher in this cohort. A Cochrane database by Middleton et al, 2020 [18] was able to show an association between induction of labor and a significant perinatal risk reduction for women with prolonged gestation.…”

Section: Discussionmentioning

confidence: 78%

Efficacy and Safety of Misoprostol Vaginal Insert to Induce Labor beyond 40 + 0 Weeks of Gestation

Krause¹,

Rudlowski²,

Erices-Leclercq³

et al. 2021

OJOG

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Objective: Misoprostol vaginal insert (MVI) is proven to induce labor by a continuously release of PGE1. Previous reports showed that MVI reduced induction to delivery time as well as active labor time but it also increased uterine tachysystole. Here we attempted to clarify whether MVI is safe and efficient for women with pregnancies >40 weeks in a single institute. Methods: This study was performed in Lutheran Hospital Bergisch Gladbach, Germany 2014-2019. A total of 304 women between 40 + 0 to 42 + 0 weeks underwent labor induction with MVI. Outcomes were: 1) maternal: time from insertion to delivery, interventions, mode of delivery, and uterine tachysystole, 2) neonatal: cord blood pH, APGAR scores, and admission to a neonatal clinic. This study ended unexpectedly due to the withdrawal of MVI (Misodel™) in September 2019. Results: 75.7% (n = 230) of women gave birth within 24 hours after MVI placement. 72.2% (n = 140) nulliparous women and 81.8% (n = 90) parous women delivered within 24 hours. In two cases emergency CS was required. 67.8% (n = 206) of women delivered vaginal. 2.3% (n = 7) of cord pH levels were below 7.10. 3.3% (n = 10) of newborns were transmitted to a neonatal clinic. Conclusion: MVI is an efficient method to induce labor for pregnant women beyond 40 + 0 weeks. However, considering various complications observed (uterine tachysystole and fetal distress leading to a high number of CS), we cannot universally advocate the use of MVI.

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Section: Discussionmentioning

confidence: 78%

Efficacy and Safety of Misoprostol Vaginal Insert to Induce Labor beyond 40 + 0 Weeks of Gestation

Krause¹,

Rudlowski²,

Erices-Leclercq³

et al. 2021

OJOG

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“…Also, some researchers reported that the rate of operative vaginal deliveries increased with delivery after 40 weeks, and the higher incidence of 3rd or 4rd degree lacerations, secondary postpartum bleeding, and prolonged labor were observed between 40 and 42 weeks, compared with before 40 weeks of gestation (1,14,19).…”

Section: Discussionmentioning

confidence: 99%

“…Based on the World health organization (WHO) definitions, postdate delivery lasting 42 weeks or more is referred to postterm, and the pregnancies between 40 and 41 + 6 weeks as late-term deliveries (1). Full term pregnancy is defined by the American Congress of Obstetricians and Gynecologists as 39 to 40 weeks of gestation (2,3).…”

Section: Introductionmentioning

confidence: 99%

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The Comparison of Perinatal Outcomes in Early Delivery Versus Postdate Labor

et al. 2017

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Background: Prenatal mortality and morbidity increase after 40 weeks of gestation. The current study aimed at comparing maternal and neonatal outcomes between term and postterm pregnancies. Methods: The current prospective cohort study was performed on 1180 singleton, cephalic fetus, and uncomplicated pregnancy cases admitted for labor. Pregnant mothers were divided into 3 groups. Group 1 included 750 cases in 38 to 40 weeks, group 2 included 250 cases in 40 to 41 weeks, and group 3 included 180 cases in over 41 weeks of gestation. Prenatal outcomes were recorded as: fetal distress, meconium passage, meconium aspiration, fetal weight ≥ 4 kg, Apgar score in 1 and 5 minutes, neonatal intensive care unit (NICU) admission, maternal infection, postpartum hemorrhage, and the rate of cesarean section. Results: There were significant differences in the rate of fetal distress (P < 0.001), meconium passage (P = 0.001), meconium aspiration syndrome (P < 0.001), Apgar score ≤ 3 at 1 (P = 0.025) and 5 minutes (P < 0.001), admission to NICU (P < 0.001), rate of cesarean section (P < 0.001), and maternal infection (P = 0.001) among the groups. The frequency of fetal distress was lower in group1 compared with group 2 (1.6% versus 4.4%; P = 0.011). Also fetal distress was significantly lower in group 1 than group 3 (1.6% versus 10.9%; P < 0.001). The meconium passage and meconium aspiration syndrome were statistically lower in group 1 compared with group 2 (1.6% versus 8%; P < 0.001 for meconium passage, and 0.9% versus 5.6%; P < 0.001 for meconium aspiration syndrome). Also meconium passage and meconium aspiration syndrome were significantly lower in group 1 compared with group 3 (1.6% versus 13.9%; P < 0.001 for meconium passage, and 0.9% versus 10%; P < 0.001 for meconium aspiration syndrome). The cesarean section was more frequent in group 2 compared with group 1 (24.8% versus 13.6%; P < 0.001) and in group 3 compared with group 1 (33.3% versus 13.6%, P < 0.001). There was no significant difference in the mean fetal weight, fetal weight ≥ 4 kg, and postpartum hemorrhage in females between the 3 groups. Conclusions: Late-term and postterm births are associated with higher rates of fetal and neonatal morbidity and maternal risks compared to pregnancy termination before 40 weeks of gestation, and earlier birth induction is recommended in such cases.

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“…Labor induction begins at 41 weeks in post-term pregnancies, according to national protocol (Khooshideh et al, 2017; Weiss et al, 2014). After 40 weeks, more than 40% of pregnant women give birth, and roughly 15% to 20% after 41 weeks.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Nomogram to Estimate Risk of Cesarean After Induction of Labor in Term Pregnancies with an Unfavorable Cervix in Iran

Hemmatzadeh

Abbasalizadeh

Mohammad‐Alizadeh‐Charandabi

et al. 2022

Clin Nurs Res

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This study aimed to develop and validate a labor induction nomogram for nulliparous and multiparous women who were 38 weeks pregnant or more and had their labor induced by an unfavorable cervix. This prospective study was conducted on 300 individuals (200 for nomogram development and 100 for nomogram validation). Height, body mass index at delivery, parity, gestational age, adjusted bishop score, and cesarean section risk assessment were all recorded on a checklist. Participants were followed until they gave birth, and the type of delivery was noted in the checklist. Out of 300 labor inductions, 80 (26.7%) underwent a cesarean section. Cesarean risk estimation was the only predictor of delivery type based on multivariate logistic regression. The AUC (Area Under the Curve) in development group was 0.68 and in validation group was 0.71. The developed nomogram for predicting of cesarean section risk following labor induction has a relatively good predictive value among women.

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S1-Guideline: Management of Late-term and Post-term Pregnancy

Cited by 10 publications

References 0 publications

Efficacy and Safety of Misoprostol Vaginal Insert to Induce Labor beyond 40 + 0 Weeks of Gestation

Efficacy and Safety of Misoprostol Vaginal Insert to Induce Labor beyond 40 + 0 Weeks of Gestation

The Comparison of Perinatal Outcomes in Early Delivery Versus Postdate Labor

Development and Validation of a Nomogram to Estimate Risk of Cesarean After Induction of Labor in Term Pregnancies with an Unfavorable Cervix in Iran

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