A Prospective Study of Induction of Labour versus Expectant Management for Pregnancies beyond 40 Weeks of Gestation

Introduction: Recent studies show increased incidence of perinatal morbidity and mortality with increase in gestational age but there is uncertainty on the policy concerning the timing of induction for prolonged pregnancy or impending post term pregnancy, leading to practice variation between caregivers. Managing pregnancies continuing beyond their due dates remains to be tricky situation for obstetrician. Present study aims to analyze and compare various maternal and neonatal parameters in pregnancies beyond expected date of delivery. Study design: This was prospective observational study.270 low risk primigravida at 40 weeks of gestation were included in the study and were divided into two groups of 135 each. Group I- patients were admitted and induced at 40 weeks and onwards till 40+6 weeks. Group II-comprised of patients who were expectantly managed till 40+6 weeks and then induced, if required. Various maternal and neonatsal parameters were studied in above two groups. Result: Patients managed expectantly till 40 +6 weeks had significantly higher vaginal delivery rate compared to patients induced at 40 weeks onwards. Similarly the incidence of meconium staining of liquor, caesarean section rate and its associated morbidity was higher in induction group. Neonatal morbidity and mortatlity were comparable in both the groups. Conclusion: Expectantly managing pregnancies till 41 weeks allows patients to go into spontaneous labour and reduces operative deliveries whereas early induction increases rate of operative delivery.