The course and outcomes of labor in relation to management tactics during prolonged pregnancy


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Abstract

The choice of wait-and-see or active tactics for prolonged and protracted pregnancy remains controversial. Objective. To compare the specif ic features of the course of labor and perinatal outcomes in women who tend to prolong pregnancy in relation to management tactics. Subjects and methods. 272 healthy primiparas at 284-285 days’ gestation were included in the study; 74 patients formed a control group; a wait-and-see tactic was used in 90 patients; labor preinduction was carried out in 108. Results. After taking mifepristone, uterine contractions occurred in 63% of the women. Preinduction was continued with dinoprostone in the others: 1 dose in 70%, 2 doses in 20%, and 3 doses in 10%. In the labor preinduction group, the rate of primary or secondary uterine inertia and dystocia was minimal, accounting for 16.6% versus 40%. In the wait-and-see tactic group, the risk of abnormal labor was 2.1 times higher than that in the control group. In the same group, the rate of oxytocin-augmented labor was significantly more common than that in the control group (30% versus 16.2%). The rate of birth to big large fetuses and babies with signs of postmaturity was seen more frequently in the wait-and-see tactic group (p < 0.05). Conclusion. Labor preinduction in women tending to prolong pregnancy at 284-285 days is a rather effective and safe method to prevent complications, allows the lower rate of birth to postmature infants, and this does not contribute to the higher rate of cesarean section and poor perinatal outcomes.

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About the authors

O. V Tychychnyi

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: olti23@mail.ru
3rd year postgraduate student of the maternity departments

O. R Baev

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: metod_obsgyn@hotmail.com
MD, PhD, professor, the head of Maternity Department

L. V Krechetova

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: l_krechetova@oparina4.ru
PhD, the head of Laboratory of clinical immunology

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