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Improved neonatal outcome after active management of prolonged pregnancies beyond 41+2 weeks in nulliparous, but not among multiparous women

Lindegren, Lina LU ; Stuart, Andrea LU ; Herbst, Andreas LU and Källe´n, Karin LU (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.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
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
  • scopus:85032829568
  • wos:000416159200011
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
2018-01-16 13:26:52
@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 (&gt; 17.6% proceeding to 42<sup>+3</sup> weeks), was compared with that among women delivered at units with the most active management (&amp;#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 &amp;#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},
  keyword      = {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},
  volume       = {96},
  year         = {2017},
}