Improved neonatal outcome after active management of prolonged pregnancies beyond 41+2 weeks in nulliparous, but not among multiparous women
(2017) In Acta Obstetricia et Gynecologica Scandinavica 96(12). p.1467-1474- Abstract
Introduction: Prolonged pregnancies are associated with adverse maternal and fetal outcome. In Sweden, no national guidelines exist for when to induce prolonged pregnancies. Material and methods: Singleton cephalic prolonged pregnancies (defined as ≥ 41+3 gestational weeks) during 2001-2013 (n = 199 770) were identified using the Swedish Medical Birth Register. The maternity units were divided into three groups (tertiles) based on the proportion of pregnancies ≥ 42+3 gestational weeks among all pregnancies ≥ 41+3 weeks. The pregnancy outcome among women delivered at the units with the most expectant management of prolonged pregnancies (> 17.6% proceeding to 42+3 weeks), was compared with... (More)
Introduction: Prolonged pregnancies are associated with adverse maternal and fetal outcome. In Sweden, no national guidelines exist for when to induce prolonged pregnancies. Material and methods: Singleton cephalic prolonged pregnancies (defined as ≥ 41+3 gestational weeks) during 2001-2013 (n = 199 770) were identified using the Swedish Medical Birth Register. The maternity units were divided into three groups (tertiles) based on the proportion of pregnancies ≥ 42+3 gestational weeks among all pregnancies ≥ 41+3 weeks. The pregnancy outcome among women delivered at the units with the most expectant management of prolonged pregnancies (> 17.6% proceeding to 42+3 weeks), was compared with that among women delivered at units with the most active management (< 12.6% proceeding to 42+3 weeks). Odds ratios (OR) were calculated using simple and multiple logistic regression. Adjustments were made for year of delivery, hospital level, maternal age, body mass index, and smoking. Results: Among primiparas, an increased risk of Apgar score < 7 at 5 minutes [odds ratio (OR) 1.27, 95% CI 1.16-1.41] and meconium aspiration (OR 1.49, 95% CI 1.14-1.95) was found after birth at most expectant units compared with most active units, but among multiparas, no such associations were detected. A decreased rate of cesarean section was found for both primiparas (OR 0.83, 95% CI 0.80-0.86) and multiparas (OR 0.82, 95% CI 0.77-0.86) at units with expectant versus active management. No association between perinatal death and delivery-unit specific management of prolonged pregnancies was detected. Conclusions: Offspring to primiparas might gain from a more active management of prolonged pregnancies, whereas no such improvement of neonatal outcome among multiparous women was detected.
(Less)
- author
- Lindegren, Lina LU ; Stuart, Andrea LU ; Herbst, Andreas LU and Källe´n, Karin LU
- organization
- publishing date
- 2017-11-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Fetal outcome, Parity, Post-term pregnancy, Practical management, Prolonged pregnancy
- in
- Acta Obstetricia et Gynecologica Scandinavica
- volume
- 96
- issue
- 12
- pages
- 1467 - 1474
- publisher
- Wiley-Blackwell
- external identifiers
-
- wos:000416159200011
- pmid:28963726
- scopus:85032829568
- ISSN
- 0001-6349
- DOI
- 10.1111/aogs.13237
- language
- English
- LU publication?
- yes
- id
- a49e956b-c2d3-43c3-b877-69596dc412ab
- date added to LUP
- 2017-12-01 13:44:14
- date last changed
- 2024-03-18 01:58:05
@article{a49e956b-c2d3-43c3-b877-69596dc412ab,
abstract = {{<p>Introduction: Prolonged pregnancies are associated with adverse maternal and fetal outcome. In Sweden, no national guidelines exist for when to induce prolonged pregnancies. Material and methods: Singleton cephalic prolonged pregnancies (defined as ≥ 41<sup>+3</sup> gestational weeks) during 2001-2013 (n = 199 770) were identified using the Swedish Medical Birth Register. The maternity units were divided into three groups (tertiles) based on the proportion of pregnancies ≥ 42<sup>+3</sup> gestational weeks among all pregnancies ≥ 41<sup>+3</sup> weeks. The pregnancy outcome among women delivered at the units with the most expectant management of prolonged pregnancies (> 17.6% proceeding to 42<sup>+3</sup> weeks), was compared with that among women delivered at units with the most active management (&#60; 12.6% proceeding to 42<sup>+3</sup> weeks). Odds ratios (OR) were calculated using simple and multiple logistic regression. Adjustments were made for year of delivery, hospital level, maternal age, body mass index, and smoking. Results: Among primiparas, an increased risk of Apgar score &#60; 7 at 5 minutes [odds ratio (OR) 1.27, 95% CI 1.16-1.41] and meconium aspiration (OR 1.49, 95% CI 1.14-1.95) was found after birth at most expectant units compared with most active units, but among multiparas, no such associations were detected. A decreased rate of cesarean section was found for both primiparas (OR 0.83, 95% CI 0.80-0.86) and multiparas (OR 0.82, 95% CI 0.77-0.86) at units with expectant versus active management. No association between perinatal death and delivery-unit specific management of prolonged pregnancies was detected. Conclusions: Offspring to primiparas might gain from a more active management of prolonged pregnancies, whereas no such improvement of neonatal outcome among multiparous women was detected.</p>}},
author = {{Lindegren, Lina and Stuart, Andrea and Herbst, Andreas and Källe´n, Karin}},
issn = {{0001-6349}},
keywords = {{Fetal outcome; Parity; Post-term pregnancy; Practical management; Prolonged pregnancy}},
language = {{eng}},
month = {{11}},
number = {{12}},
pages = {{1467--1474}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Obstetricia et Gynecologica Scandinavica}},
title = {{Improved neonatal outcome after active management of prolonged pregnancies beyond 41<sup>+2</sup> weeks in nulliparous, but not among multiparous women}},
url = {{http://dx.doi.org/10.1111/aogs.13237}},
doi = {{10.1111/aogs.13237}},
volume = {{96}},
year = {{2017}},
}