PREGNANCY

MANAGEMENT & OUTCOME BEFORE AND AFTER 41 WEEKS

Abstract

Aims and Objectives: To evaluate whether serial monitoring of fetuses beyond 40 weeks with biophysical profile and non-stress test improves the fetal outcome in terms of morbidity and mortality determined by APGAR score at 5 minutes, presence of meconium in liquor, weight of baby and admission of neonate in nursery and to compare the maternal morbidity associated with prolonged pregnancy, labour induction and mode of delivery in the study and control group. Materials and Methods: It is a prospective controlled study conducted in the department of obstetrics and gynaecology Ghurki Trust Teaching Hospital, Lahore from 1st September 2007 to 31st August 2009. 200 patients at 40 weeks of pregnancy matching the inclusion criteria were enrolled for the study. They were divided into a study and a control group consisting of 100 patients each. Patients in the study group were subjected to fetal monitoring in the form of cardiotocography (CTG) and biophysical profile (BPP) while those in the control group were evaluated clinically and by kick count chart (KCC). The outcome of the two groups beyond 40 weeks was compared with each other. Results: The percentage of patients reaching 42 weeks was 4 in each group. The rest went into spontaneous labour, were induced or had emergency caesarean sections due to various reasons. The difference between the rest of the parameters like maternal morbidity, mode of delivery, fetal APGAR score and admission in neonatal intensive care unit (NICU) between the two groups were not statistically different. Conclusions: After 40 weeks of gestation fetal monitoring should be started with proper counseling of the patient, clinical assessment and fetal kick chart. NST and biophysical profile should be used selectively in patients with sluggish fetal movement or suspected reduced liquor clinically. All patients who reach 42 weeks must be induced.