INDUCTION OF LABOUR;

ROUTIVE INDUCTION AT 40 WEEKS OF PREGNANCY

Abstract

Objective: The aim of this study to justify induction of labour at 40 weeks of pregnancy in our population. Design: Quasi experimental study. Place and duration: Combined Military hospital Attock, Obstetric and Gynaecology Department from 1.6.2011 to 1.2.2012. Material and method: 100 patients were selected from outpatient department, and divided into two groups, group A, with 50 patients at 40 weeks and group B with 50 patients at 41 weeks. Booked or unbooked patients with singleton pregnancy with cephalic presentation, were selected by non propability consecutive sampling technique. Pregnancy with previous scar, medical disorder, polyhydramnios, multiple fetal and uterine abnormality and intrauterine death, placenta previa, were ruled out excluded from study. Postdate pregnancy was confirmed clinically by last menstrual period and early dating ultrasound. Patients were clinically followed for fundal height, presentations and FHR. Bishop scoring was done and patients were induced mechanically with cervical foley and vaginal pessary PGE2 according to bishop score. Amniotomy was done at bishop score more than 7. Labour was monitored with full protocol. Same procedure was repeated for group B of 50 patients who were selected according to criteria, for induction of labour at 40 weeks of pregnancy. Maternal and fetal outcome was analysed in term of mode of delivery and APGAR score respectively. Results: Out of 100 patients, 50 patients with age 20 to 35 year, presenting at 40 weeks were included in group A. Spontaneous vaginal delivery was seen in 30 patients (60%), 4 by vaccum(8%), 3 by forcep delivery (6%), 13 patients ended up into emergency LSCS (26%). In group B of 50 women, planned for induction at 41 weeks, emergency cesareans were 23 (46%). MAS was in 9(18%) babies as compared to 2% in group A and, Fetal distress (type 2 dips) were found in 3(6%) cases. Neonatal outcome was assessed with help of APGAR score. Babies delivered with good APGAR were 47 in group A, as compared to 41 in group B. Rate of vaginal delivery was high in group A (74%) induced at 40 weeks. Results were analysed by using SPSS 10 and p-value was found to 0.024. No difference was found in the incidence of fetal outcome with APGAR SCORE 10, and fewer babies were with poor APGAR SCORE and p=0.051. Conclusions: Induction at 40 weeks may reduce perinatal mortality and incidence of MAS. It does not increase risk of caesarean section when compared with induction at or beyond 41 weeks.