Maternal risk factors for postterm pregnancy and cesarean delivery following labor induction

NATHALIE ROOS1 , LENA SAHLIN1 , GUNVOR EKMAN-ORDEBERG1 , HELLE KIELER2 & OLOF
STEPHANSSON1,2

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.3109/00016349.2010.500009

Results. Among 1,176,131 births, 8.94% were delivered postterm. Compared to normal weight
women, the risk of postterm pregnancy in obese women was almost doubled (adjusted OR: 1.63,
95% CI 1.59–1.67). The risk of postterm pregnancy increased with increasing maternal age and was
higher among primiparous women. The risk of cesarean section (CS) following labor induction
postterm, increased with maternal age and BMI, and was more than doubled among women 35
years and older (adjusted OR 2.28, 95% CI 2.04–2.56). A fivefold risk of CS was seen among
nulliparous women (adjusted OR 5.05, 95% CI 4.71–5.42). Parous women with a previous CS
undergoing labor induction had a sevenfold increased risk of CS postterm (adjusted OR 7.19, 95% CI
5.93–8.71). Conclusions. Nulliparity, advanced maternal age and obesity were the strongest risk
factors for postterm pregnancy and CS following labor induction in postterm pregnancy. Including
maternal risk factors to the cervical assessment may improve prediction of vaginal delivery following
labor induction in postterm pregnancy.

A clinical study of postdated pregnancy Shilpa Nitin Chaudhari1*, Devika B. Bhikane2 , Priyanka
Gupta3

https://www.ijrcog.org/index.php/ijrcog/article/viewFile/2329/2326

Results: There is high fetal and maternal risk associated with postdated pregnancy. Total 100 cases
were selected from antenatal clinic and Labour Room and were divided into two groups. Study group
and control group, 50 cases in each. Induction rate is more in postdated pregnancies. Incidence of
operative deliveries is 54% in study group. Postpartum haemorrhage and septicaemia are the most
common maternal complication in the study group. Perinatal mortality is higher and more NICU
admissions were required. Conclusions: Considering this, policy of early intervention should be
undertaken in postdated pregnancy to avoid maternal and perinatal complications.

s induction rate wise distribution of cases in study group. 19(38%) cases in study group required
induction as compared with 10(20%) cases in control group. This mean number was analyzed
quantitatively within group. The p value is < 0.05 which is statistically significant.

. Commonest indication was fetal distress in study group which contributed for 28% compare to
control group it was 14%. Total 27% ceserian sections were done in study group. Some of them had
more than one indication (like severe oligohyramnios with fetal distress) so no. of indications is not
matching in above table. The p value is statistically not significant. (p>0.05).

Incidence of post dated pregnancies was more in age group 21 to 25 yrs followed by 26 to 30yrs in
study group. Majority of postdated pregnancy were seen in age group of 25 to 29 yrs in this study.
Mode of delivery was not significantly associated with post dated pregnancy compared with term
pregnancy. Similar finding was also observed in a study conducted by Katz et al who tested non-
aggressive approach to the management of post-date pregnancies involving 156 patients who had
reached 294 days of amenorrhea and had a Bishops score of 4 or less.17 The numbers of caesarean
sections were more in postdated pregnancy compared with normal term pregnancy and it was
statistically significant in their study. In our study same finding was observed but the difference was
statistically not significant. Similar finding was also observed in a study conducted by Luckas et al
which compared outcomes of spontaneous labor in uncomplicated term and post date pregnancy.
Cesarean section was significantly more common in women with post dated pregnancy.18

Postdated pregnancy is not related with age and parity. Common factors associated postdated
pregnancies is severe oligohydroamnios. Count to 10 i.e. Daily fetal movement count (DFMC)
method is important alternative to use of electronic fetal monitoring. Induction rate is more in
postdated pregnancies. Meconium in the amniotic fluid is found in 12% cases in study group.
Incidence of operative incidence is more when oligohydramnios and postdated pregnancy present
together i.e. 16% in study group and 10% in control group. Incidence of operative deliveries in
postdated group is significantly high. Most common indication of cesarean section was fetal distress
(28%). Post partum hemorrhage (PPH) occurred in 8% of patients and septicemia in 2% of patients,
in study group. Average birth weight observed was in range of 3 to 3.5 kg (46%) in study group
compared to (24%) in control, which was statistically significant. Incidence of fetal distress was 14%
in control group and 28% in study group. Perinatal death was seen in 2% due to birth asphyxia in
case group and nil in control group. More number of newborns required NICU admission among post
dated pregnancy. Transient tachypnea of newborn was common reason requiring NICU admission
among the post dated pregnancy.

Delaney, M., Roggensack, A., Leduc, D. C., Ballermann, C., Biringer, A., Delaney, M., …
Wilson, K. (2008). Guidelines for the Management of Pregnancy at 41+0 to 42+0 Weeks.
Journal of Obstetrics and Gynaecology Canada, 30(9), 800–810. doi:10.1016/s1701-
2163(16)32945-0 

There was a statistically significant higher rate of Caesarean section among women who were
monitored than among those induced (24.5% vs. 21.25%, P = 0.03; OR 1.22; 95% CI 1.02–1.45), and
this difference was due to a lower rate of this procedure for fetal distress.

They acknowledge that this could account for the difference in the rate of Caesarean section. Also,
this trial was not blinded, which introduces the potential for bias toward a higher Caesarean rate, as
pregnancies are likely to be considered higher risk as they became further post-term. The authors
conclude that labour induction in post-term pregnancies decreases the Caesarean rate but leads to
no difference in the incidence of perinatal mortality and morbidity.

The evidence suggests that the rate of Caesarean section is either reduced or not increased when
women are induced, compared with those expectantly managed
Prevalence of postterm births and associated maternal risk factors in China: data from over 6 million
births at health facilities between 2012 and 2016 Kui Deng 1,4, Yan Huang2, YanpingWang1, Jun
Zhu1,4, Yi Mu1, Xiaohong Li1, AiyunXing3, Zheng Liu1, Mingrong Li1, XiaodongWang3 & Juan Liang 1

https://www.nature.com/articles/s41598-018-36290-7.pdf

However, our study detected that primiparous women had a slightly reduced risk of postterm births.
Tis correlation may be related to the extremely high rate of caesarean sections in Chinese women.
Due to a variety of factors—such as rapid urbanization, increased hospitalization during childbirth,
fnancial incentives for healthcare providers to perform caesarean deliveries, and maternal requests
for caesarean deliveries because of their anxiety about labor, fear of pain, and desire to choose an
auspicious delivery date—the rate of caesarean deliveries in China has rapidly increased during past
decades2

Study of post dated and term pregnancy with fetomaternal outcome at RRMCH Punya BS1,*,
Sailakshmi MPA2

https://www.ipinnovative.com/journal-article-file/4064

Results: In the present study, total of 2174 cases were studied out of which 486 cases were post
dated pregnancies. The incidence of post dated pregnancy was 17.36%. PRIMIs were more prone for
post dated pregnancies according to our study. The ‘P’ value was statistically significant (p

Incidence of post term pregnancy in our study is 0.36%. The present study shows lower incidence
because of the awareness in people about post term pregnancies and precautions are always taken
at our hospital not to allow the pregnancy to go beyond 42 weeks of gestation age and elective
induction is done at 40+0 weeks here. This shows the need to concentrate on postdated pregnancies
as very few cases go till post term.

https://www.aafp.org/afp/2014/0801/afp20140801p160.pdf

https://www.jpeds.com/action/showPdf?pii=S0022-3476%2813%2901414-5

Putri : http://repository.unusa.ac.id/3411/
 oleh Roos, et al menunjukkan nulliparitas merupakan salah satu faktor risiko terkuat

untuk kehamilan postdate dan persalinan CS. Hasil penelitian ini juga bertentangan dengan

penelitian