The Incidence and Outcomes of Late-Term Pregnancy

Ranjbar, Amene; Mehrnoush, Vahid; Darsareh, Fatemeh; Pariafsay, Faranak; Jahromi, Malihe Shirzadfard; Shekari, Mitra

doi:10.7759/cureus.33550

Cited by 2 publications

(1 citation statement)

References 13 publications

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“…Ranjbar's study was carried out in Bandar Abbas city (urban area, with elevation of 9m above sea level), Iran between January 2020 and 2022. 7 Kandalgaonkar et al in a prospective cross-sectional study of 5110 participants in India, prevalence of postdate pregnancies was 5.1% and there was increased use of c-section delivery in postdated pregnancies compared to term pregnancies.…”

Section: Introductionmentioning

confidence: 96%

Rural, Low-Income, High-Altitude Population: Burden, Determinants of Postdate Pregnancies and Neonatal Phenotype

Ogah,

Ogbole

2023

Preprint

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Background Conditions, which reduce oxygen delivery to the fetus, are associated with impaired intrauterine growth. Postdate babies are thought to be rare in today s neonatal practice. The combined effects of prolonged gestation, high altitude and rural-low-income residence on fetal growth and hence timing of delivery, have been poorly investigated. This study examined and compared the burden, determinants and neonatal phenotypes of term and postdate pregnancies in a remote, high-altitude (1674m above sea level) community. Subject and methods This was the secondary analysis of the baseline data collected for a prospective cohort study. Healthy, 529 mother-singleton infant pairs were recruited consecutively from a rural district hospital. Newborns were classified by their gestational age and weight according to WHO. Gestational age was determined by mother s LMP, fetal ultrasound dating and post-delivery ballard examination. Postdate was defined by gestation >40weeks. Preterm babies (26-4.9%) were excluded, remaining with 503 babies that were used in the analysis. Logistic regression models and chi test were used to compare the characteristics of term and postdate deliveries. Results Of the 503 mother-infant study participants, postdate babies were 199 (39.6%) and SGA babies were 108 (21.4%). Overall, SGA birth rate was 4 times higher than the preterm birth rate. There was greater odds of SGA birth (p<0.001; OR=11.05; 95% CI 3.74, 35.57), especially symmetrically growth retarded SGA (p=0.003; OR=6.60; 95% CI 1.67, 26.1) in postdate delivery compared to term delivery. Though birthweight was preserved, the rate of SGA delivery progressively increased from 14.3% at 38weeks to 80% at 43weeks gestation. The rate of AGA delivery peaked at 40 weeks gestation (85.6%) and thereafter declined. Maternal married status (p=0.009, OR=2.27) and high MUAC (p=0.049; OR =1.74) promoted postdate pregnancy. Mothers (80%, p=0.005) engaged in professional occupation had a tendency to prolonged pregnancy. Good environmental (water and toilet) sanitation was more likely to result in postdate delivery, p<0.05. Conclusion and Recommendations The rates of postdate and SGA births were unexpectedly high for the level of altitude. Unlike in low land studies, where prolonged pregnancies were associated with macrosomia, postdate deliveries in this high-altitude population, were more commonly associated with SGA birth and their complications. The strong association of symmetric SGA (rather than asymmetric SGA) with postdate pregnancies suggests longstanding intrauterine insult from probably combined effects of chronic hypoxia from high altitude residence and maternal factors. The authors of this study strongly recommend that high-altitude pregnancies should not be allowed to progress beyond 40weeks gestation and more resources should be committed to identifying high risk pregnancies with tendencies for prolonged pregnancies and improve maternal nutrition and oxygen status during pregnancy. Newborns should be classified at birth, their problems anticipated and managed appropraitely for an improved neonatal care, survival and wellbeing. KEY WORDS: Postdate, SGA, symmetrical SGA, AGA, maternal MUAC, environmental sanitation, high altitude, rural.

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Section: Introductionmentioning

confidence: 96%

Rural, Low-Income, High-Altitude Population: Burden, Determinants of Postdate Pregnancies and Neonatal Phenotype

Ogah,

Ogbole

2023

Preprint

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Contributing factors of birth asphyxia in Thailand: a case–control study

Rattanaprom,

Ratinthorn,

Sindhu

et al. 2023

BMC Pregnancy Childbirth

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Background Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia. Methods A case–control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software. Results The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal–fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia. Conclusion Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

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The Incidence and Outcomes of Late-Term Pregnancy

Cited by 2 publications

References 13 publications

Rural, Low-Income, High-Altitude Population: Burden, Determinants of Postdate Pregnancies and Neonatal Phenotype

Rural, Low-Income, High-Altitude Population: Burden, Determinants of Postdate Pregnancies and Neonatal Phenotype

Contributing factors of birth asphyxia in Thailand: a case–control study

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