ARE THERE ANY DIFFERENCE IS PREGNANCY OUTCOMES BETWEEN TERM AND PROLONGED PREGNANCIES?

Abstract

Aim: To compare obstetric and perinatal outcomes of the prolonged and full-term pregnancy patients. Materials And Method: Between January and March 2012 with gestation of 40 weeks and over, 658 patients were prospectively evaluated at Zekai Tahir Burak Women’s Health Education and Research Hos- pital . According to our clinical protocol, 40-413 and 414-42 week patients were divided into two groups. In the control group, 128 patients were under 40 week’s gestational age. Age, gravida, parity, body mass index, duration of labor, latent and active phases, the total administration time of oxytocin, amniotomy, the presence of meconium, NST changes were recorded. Types of delivery, birth weight of infants were noted. Indications for cesarean section and maternal and newborn complications were investigated. Results: In group 1, 536 and group 2, 122 patients were evaluated. Between the groups there was no difference in age, gravidity, parity, body mass index, duration of latent and active phases of labor and total administration time of oxytocin. No meconium was observed in the control group, group 1 and group 2 showed a significant difference in rate of meconium. Amniotomy, presence of non-reactive NST and the rate of the cesarean in labor were significantly higher in group 1 and group 2 than control group. Baby weights were significantly higher in fetal weight in the group 1 3512 ± 25 g and group 2 3552 ± 57 g were significantly higher in fetal weight in the control group 3279 ± 46 g p = 0.0005 . Over 40 weeks four babies are lost due to perinatal asphyxia whereas six were followed because of temporary dyspnea. Conclusion: The gestational age is important for obstetric and perinatal outcomes.

Keywords

• Prolonged pregnancy,obstetric,perinatal outcome.

UZAMIŞ GEBELİKLERDE PERİNATAL VE OBSTETRİK SONUÇLAR TERM GEBELİKLERDEN FARKLI MI?

Abstract

Amaç: Uzamış ve term gebelik nedeniyle izlenmiş hastaların obstetrik ve perinatal sonuçlarının karşılaştırılması. Gereçler ve Yöntem: Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi doğum ünitesine 2012 Ocak-Mart ayları arasında yatırılan 40 hafta ve üzeri 658 gebe prospektif olarak değerlendirildi. Hastalar klinik protokolümüze göre 40-413 ve 414-42 hafta olmak üzere iki gruba ayrıldı. Kontrol grubu olarak gebelik haftası 40 haftanın altında olan 128 hasta alındı. Gebelerin yaşı, gravidası, paritesi, vücut kitle indeksleri, doğum eyleminin latent ve aktif fazlarının süresi, toplam oksitosin uygulama süresi, amniyotomi, mekon- yum varlığı, non reaktif non stres test NST değişiklikleri kayıt edildi. Olguların doğum şekilleri, bebeklerin doğum kilosu not edildi. Sezaryen endikasyonları ile anneye ve yenidoğana ait komplikasyonlar araştırıldı. Bulgular: Grup I’de 536, Grup II’de 122 hasta değerlendirmeye alındı. Gruplar arasında yaş, gravida, parite, vücut kitle indeksi, doğumun latent ve aktif faz süreleri, toplam oksitosin uygulama süresi açısından fark bulunamadı. Kontrol grubunda mekonyum gözlenmezken, Grup I ve Grup II’de mekonyum izlenme oranı anlamlı farklılık gösterdi. Amniyotomi ve NST varlığı ile eylemde sezaryen oranı kontrol grubuna göre Grup I ve Grup II’de anlamlı olarak fazla bulundu. Bebek kilosu değerlendirildiğinde kontrol grubuna 3279 ± 46 g göre, Grup I 3512 ± 25 g ve Grup II’de 3552±57 g doğum ağırlığı anlamlı olarak yüksek bulundu p=0.0005 . Perinatal asfiksi nedeniyle 40 hafta üzeri dört bebek kaybedildi; altı bebek geçici dispne nedeniyle yoğun bakımda takip edilerek haliyle taburcu edildi. Sonuç: Gebelik süresinin uzaması obstetrik ve perina- tal sonuçları değiştirmektedir.

Keywords

• Uzamış gebelik,obstetrik,perinatal sonuç

References

1. 1. Rayburn WF, Chang FE: Management of the uncomplicated postdate preagnancy. J Reprod Med 1981; 26(2):93-5.
2. 2. American College of Obstetricians and Gynecologists. Diagnosis and management of postterm pregnancy. Washington, DC: ACOG Technical Bulletin No. 130,1989.
3. 3. American College of Obstetricians and Gynecologists. Management of postterm pregnancy. Washington, DC: ACOG Practice Patterns No. 6,1997.
4. 4. Feldman GB. Prospective risk of stillbirth. Obstet Gynecol 1992; 79:547-53.
5. 5. Bakketeig LS, Bergjo P. Post-term pregnancy. Magnitude of the problem. In:Enkin M, Keise MJ, Chalmers I, eds. Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989.
6. 6. Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond term. Cochrane Database Syst Rev 2004;(3):CD000170.
7. 7. Zimmer EZ, Paz Y, Goldstick O. Computerized analysis of fetal heart rate after maternal glucose ingestion in normal pregnancy. Obstet Gynecol, 2000; 93: 57-60.
8. 8. Arias F: Predictability of complications associated with prolongation of pregnancy. Obstet Gynecol 1987; 70:101-6,.

9. 9. Grausz JP, Heimler R: Asphyxia and gestational age. Obstet Gynecol 1983., 62:175-9
10. 10. Bocher CJ, Williams HI J, Castro L, Medearis A, Hobel CJ, Wade M: The efficacy of starting postterm antenatal test ing at 41 weeks as compared with 42 weeks of gestational age. Am J Obstet Gynecol 1988; 159:550-4.
11. 11. Guidetti DA, Divon MY, Langer O: Postdate fetal surveillance: is 41 weeks too early? Am J Obstet Gynecol 1989; 161:91-3
12. 12. McLain CR: Amniography studies of the gastrointestinal motility of the human fetus. Am J Obstet Gynecol 1963; 86:1079-87-.
13. 13. Cucco C, Osborne MA, Cibils LA: Maternal-fetal outcomes in pro longed pregnancy. Am J Obstet Gynecol 1989; 16:916-20.
14. 14. Usher RH, Body ME, Lean FH, Kramer MS: Assessment of fetal risk in postdate pregnancies. Am J Obstet Gynecol 1988; 158:259- 64.
15. 15. Pollack RN, Divon MY: Macrosomia in postdates pregnancies. The accuracy of routine ultrasonographic screening. Am J Obstet Gynecol 1992; 167(1):7-11
16. 16. Eden RD, Gergely RZ, Suhifrin BS, Wade ME: Comparison of antepartum testing schemes for the management of the postdate pregnancy. Am J Obstet Gynecol 1982; 144:683-92,.
17. 17. Zwerdling MA: Factors pertaining to prolonged pregnancy and its outcome. Pediatrics 1967; 69:296-300
18. 18. Wu YW, Backstrand KH, Zhao S, Fullerton HJ,Johnston SC. Declining diagnosis of birth asphyxia in California: 1991-2000. Pediatrics 2004;114(6):1584-90.