Volume 6, Issue 1, January – 2021 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Study of Prolonged Pregnancy between 40-42 weeks

Vibha Pandey1, Swati Shiradkar2
1 2
Junior Resident , Professor and HOU , Department of Obstetrics and Gynaecology, M.G.M Medical College and Hospital,
Aurangabad, Maharashtra, India

Abstract:- year of life, increase in NICU admission and still birth

birth[3,4].The placenta ceases to grow causing placental
Introduction: Prolongation of pregnancy complicates up insufficiency. The baby continues to grow but the placental
to 10% of all pregnancy and increases the risk to mother growth stops[5,6]. Post term pregnancy along with its dreaded
and fetus. Post term pregnancy along with its dreaded complications, is also cause of significant anxiety for mother
complications causes significant anxiety for mother as as well as the obstetrician. With improved antenatal care
well as obstetrician. Aim & objectives: To study the like dating scan and other antenatal diagnostic capabilities
maternal and foetal outcome in prolonged pregnancy there is early recognition of condition and thereby leading to
who delivered between 40-42 weeks. Material and increased incidence of medical and surgical intervention
method: The study was carried out in the Department of before 42 weeks. As a result pregnancy rarely pregnancy
Obstetrics and Gynaecology, Mahatma Gandhi Medical goes beyond 42 weeks. Post term pregnancy is a proved risk
College and hospital, Aurangabad from March 2019- factor for maternal and foetal complications but postdated
March 2020.Total 237 antenatal women were included in pregnancy is less studied. So, 40-42 weeks is a grey zone
the study who presented to MGM OPD and labor room and hence, here is the attempt made to study the maternal
during 40-42 weeks of gestational age. Results: There and foetal outcome of prolonged pregnancy who delivered
was no difference in percentage of spontaneous onset of between 40-42 weeks.
labour in both the groups. The proportion was more in
direct LSCS in 41-42 weeks but it is not statistically Aim and Objectives:
significant. There is no significant difference in bishop 1. To study the maternal outcome in prolonged pregnancy.
score of two groups. Response to induction was 2. To study the foetal outcome in prolonged pregnancy.
significantly good in 41-42 weeks in spite of no
significant difference in the bishop score. Unfavourable II. MATERIAL AND METHODS
foetal outcome was slightly more in 41-42 weeks. Atonic
PPH was the most common maternal complication in 41- Study period: March 2019-March 2020
42 weeks and the reason for ICU admission was Study Design: Cross sectional study.
haemorrhagic shock. Conclusion: Spontaneous onset of Study place- Department of Obstetrics and Gynaecology,
labour was same in both the groups so waiting beyond 41 Mahatma Gandhi Medical College and Hospital,
weeks may not necessarily improve the chances of Aurangabad.
spontaneous onset. After induction the occurrence of Sample size-237
vaginal delivery was more in 41-42 weeks, but maternal
and foetal complications also increased in this group. We Data included the demographic information,
should individualise each case to go beyond 41 weeks information on reproductive history, clinical presentation,
and more efforts should be made on the ripening of mode of delivery and complications that occurred during the
cervix to decrease the chances of LSCS. pregnancy, delivery and neonatal period.

Keywords:- Prolonged Pregnancy, Post Dated Pregnancy, Inclusion Criteria: All antenatal women who presented to
Post Term Pregnancy, Induction Of Labour, Maternal And MGM OPD and labor room during 40-42 weeks of
Fetal Outcome. gestational age were included in the study.

I. INTRODUCTION Exclusion Criteria: None

Fernando Arias defines prolonged pregnancy as those Observation and Results:

pregnancies beyond the expected date of delivery. [1] Post- Total number of deliveries from March 2019 – March 2020
dated pregnancy is defined as pregnancy beyond 40 weeks = 3105
of gestation and post-term is beyond 42 weeks of gestational Total patients in the study (40-42 weeks): 237
age. Prolongation of pregnancy complicates up to 10% of all Incidence of prolonged pregnancy in my study is: 7.6%
pregnancies and carries increased risk to mother and fetus. [2] Divided into 2 groups
The maternal complications are labour dystocia, operative Group A (40-40.6 weeks) - 211
vaginal delivery, increased incidence of LSCS, increased Group B (41-42 weeks) – 26
incidence of PPH. The foetal complications are increased
incidence of macrosomia, polycythemia , foetal distress,
meconium aspiration, dysmaturity, infant death in the first

IJISRT21JAN238 www.ijisrt.com 1060

Volume 6, Issue 1, January – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Table no: 1 - Spontaneous onset of labour Table no 5: Direct LSCS (N=52)
GROUP Yes No Total Maternal Foetal causes Total
40-40.6 76 (36%) 135 (64%) 211 (100%) causes
weeks 40-40.6 28(63.63%) 16(36.36%) 44 (100%)
41-41.6 9 (34.61%) 17 (65.38%) 26 (100%) weeks
weeks 41-42 6 (75%) 2 (25%) 8(100%)
Total 85 152(64.14%) 237(100% ) weeks
(35.86%) Total 34(65.38%) 18(34.61%) 52(100%)

Chi square: 01 P- value: 0.88 Chi square: 0.790602

Probability: 0.929
In both the groups, there was no difference in
percentage of spontaneous onset of labour Out of the maternal causes for direct LSCS in group A
, and group B the most common maternal cause was
Table no 2: Patients with no spontaneous onset of labour previous LSCS who are not induced according to the
(N=152) department protocol. In group A, the most common foetal
INDUCED DIRECT TOTAL cause was foetal distress. In group B most common foetal
LSCS cause was severe oligohydramnios.
40-40.6 91(67.40%) 44(32.60%) 135(100%)
weeks Table no 6: Foetal outcome
41-42 9(52.94%) 8(47.06%) 17(100%) Favourable Unfavourable Total
weeks 40- 195 (92.42%) 16 (7.58%) 211 (100%)
Total 100(65.785) 52(34.21%) 152(100%) 40.6
weeks
Chi square: 1.40 P value = 0.236 41-42 23 (88.46%) 3 (11.54%) 26 (100%)
The proportion was more in direct LSCS in 41-42 weeks but weeks
it was not statistically significant. Total 219(92.4%) 18(7.59%) 237(100%)

Table no 3: Bishop score (N=100) Chi square: 01

Unfavourable Favourable Total Probability: 0.885
40-40.6 20(21.97%) 71(78.02%) 91(100%) Unfavourable foetal outcome was slightly more in group B
weeks
41-42 2 (22.2%) 7 (77.7%) 9(100%) Table no 7: Maternal Complications
weeks Atonic ICU DEATH
22(22%) 78(78%) 100(100%) PPH
40-40.6 0 1 0
Chi square: 0.54 WEEKS
Probability: 0.941 41-42 2 1 0
No significant difference in the Bishop score of two groups. WEEKS
TOTAL 2 2 0
Table no 4: Induction of labour (N=100)
GROUP VAGINAL LSCS TOTAL The reason for ICU admission in group A was not
40-40.6 60 (65.93%) 31 (34%) 91 (100%) related to pregnancy. The reason for ICU admission in
weeks group B was haemorrhagic shock.
41-42 9 (100%) 0 9(100%)
weeks III. DISCUSSION
TOTAL 69(69%) 31(31%) 100(100%)
In my study, in both the group there was no difference
Chi square: 4.41 in percentage of spontaneous onset of labour. In my study
Probability 0.035 35% went into spontaneous onset of labour. In a study
conducted by Shetal Prajapati et.al only 26% went into
Response to induction was significantly good in group spontaneous onset of labour.[7]
B inspite of no significant difference in the Bishop score.
In my study, no significant difference in the bishop
Note 1: Induction of labour was done using Dinoprost gel. score of the two groups. This result was supported by a
Misoprostol was not used for induction as per institutional study conducted by Daniella Nave et.al that bishop score is
protocol. not a good predictor for success of labour induction. [8] In a
Note 2: Two patients required oxytocin for augmentation of similar study Kolkman et.al bishop score is poor predictor
delivery in each group. for outcome of induced labour.[9]

IJISRT21JAN238 www.ijisrt.com 1061

Volume 6, Issue 1, January – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
In my study, response to induction of labour was [7]. Prajapati S, Chavda D. Retrospective study of post
significantly good in the 41-42 weeks in spite of no term pregnancy and its outcome. Int J Reprod
significant difference in the bishop score. A study done by Contracept Obstet Gynecol 2017;6:4274-6
Ahmad Akram et.al it was observed that induction of labour, [8]. Navve D, Orenstein N, Ribak R, Daykan Y, Shechter-
the chances of vaginal delivery was more. [10] In a study by Maor G, Biron-Shental T. Is the Bishop-score
Nikhil Anand et.al it concluded that after induction of labour significant in predicting the success of labor induction
occurrence of vaginal deliveries was more. [11] in multiparous women? J Perinatol. 2017
May;37(5):480-483.
Induction of labour increases [9]. Kolkman DG, Verhoeven CJ, Brinkhorst SJ et al The
occurrence of vaginal deliveries bishop score as a predictor of labor induction success:
My study Significant A systematic review. Am J Perinatol 2013; 30: 625–
Ahmad Akram Significant 630
et.al [10]. Ahmad Akram, Isha Patel, S.V. Anandhi et al, Clinical
Nikhil Anand et.al Significant Observation of dinoprostone to induce labor in
postdatism: success, side-effect, acceptability;
In my study, unfavourable foetal outcome was slightly International Journal of Medical and Pharmaceutical
more in group B. In a study conducted by Cheng et.al. also Sciences2013; Vol.03(08)P.14-21
revealed that the risk of adverse perinatal outcome increases [11]. Anand N et al. A clinical study of maternal outcome in
gradually after 41 weeks.[12] post dated pregnancy in a tertiary care hospital Int J
Reprod Contracept Obstet Gynecol. 2019
In my study, the reason for ICU admission in 40-40.6 Sep;8(9):3573-3577
weeks and not related to pregnancy. The reason for ICU [12]. Cheng YW, Bruckner TA Caughey AB. Increased
admission in the group 41-42 weeks was haemorrhagic neonatal mortality among post-term births in
shock due to PPH. In a study Galal et. all the rate of PPH California. Am J Obstet Gynecol. 2008;199:421
increased by the weeks of gestation.[13] [13]. Galal M., Symonds I., Murray H., Petraglia F., Smith
R. Postterm pregnancy. Facts Views Vis.
IV. CONCLUSION ObGyn. 2012;4:175–187

Spontaneous onset of labour was same in both the

groups so waiting beyond 41 weeks may not necessarily
improve the chances of spontaneous onset. After induction
the occurrence of vaginal delivery was more in 41-42
weeks, but maternal and foetal complications also increased
in this group. We should individualise each case to go
beyond 41 weeks and more efforts should be made on the
ripening of cervix to decrease the chances of LSCS.

REFERENCES

[1]. Fernando Arias, Practical guide to high risk pregnancy

and delivery 3 Edition; India Harcourt private limited;
2008:255-270
[2]. Olesen AW, Westergaard JG, Olsen J. Perinatal and
maternal complications related to post term delivery: a
national register-based study, Am. J Obstet Gynecol.
1978-1993;189:222-227
[3]. Chaudhari SN, Bhikane DB, Gupta P. A clinical study
of postdated pregnancy. Int J Reprod Contracept
Obstet Gynecol 2017;6:2077- 82
[4]. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC,
Larry CG, Wenstrom KD. Post-term pregnancy. 23rd
ed. In: William’s Obstetrics. New York: McGraw-Hill
Companies; 2010:832-41
[5]. Hovi M, Raatikainen K, Heiskanen N, Heinonen S.
Obstetric outcome in post-term pregnancies: time for
reappraisal in clinical management. Acta Obstet
Gynecol Scand. 2006; 85(7): 805 -9
[6]. Burkitova A.M., Polyakova V.O., Bolotskikh V.M.,
Kvetnoy I.M. Features of the placenta structure in
post-term pregnancy // Journal of obstetrics and
women's diseases. – 2019,Vol. 68.N.6,P. 73-86.

IJISRT21JAN238 www.ijisrt.com 1062