Obstetric Outcome of Spontaneous Labour Compared to Induced Labour Beyond 40 Weeks of Gestation

Abstract

Introduction: As the pregnancy continues beyond 40 weeks of gestation, there are higher risks of developing fetal distress, fetal death due to decline in placental function and increased operative delivery. The optimal management of pregnancy beyond 40 weeks is unclear and it includes elective induction of labour or expectant management till patient may go into spontaneous labour or require cesarean section. Materials and Methods: This is a prospective study conducted in the Department of Obstetrics and Gynecology, at Subbaiah Institute of Medical sciences over a period of 1 year. 200 pregnant women who have crossed their expected date of delivery and admitted to the hospital were included in the study. These women were delivered by either induced labour or spontaneous labour and their maternal and fetal outcome was noted. They were divided into two groups. Group A were women in spontaneous labour and group B were women selected for induction of labour. Results: The two groups were matched with respect to parity, gestational age (in weeks), presenceof oligohydramnios and need for augmentation with oxytocin. Amongst the studysubjects with group A, cesarean section rate was 23% and with group B it was 12%. When the groups were subdivided by gestational age, between 40weeks- 40 weeks 6days, cesarean section rates were similar in both the groups. At 41 completed weeks of gestation, the rates of cesarean section was less in group B (8.33%) as compared to group A (40%). This difference was statistically significant with p value <0.001. Fetal distress was the most common indication for cesarean section in both the groups. Meconium stained liquor was 13.88 % in group B and 48.57% in group A during 41weeks-41weeks + 6days of gestation which was a statistically significant (p-valve 0.006). Conclusion: According to the present study, the induction of labour in pregnancy beyond 41 weeks of gestation is associated with reduction in presence of meconium staining of liquor, perinatal morbidity and decreased rates of cesarean section as compared to pregnancies who are left for spontaneous onset of labour.