Comparison of Pregnancy Outcomes Between Early/full Term and Late/post Term Gestations at Kenyatta National Hospital Between 2017 and 2019: a Comparative Cross-sectional Study

Abstract

Background: As pregnancy continues past the expected due date, there is increased risk of both maternal and perinatal complications during pregnancy, labour or following birth and this is especially so for late and post term pregnancies. Currently, there is limited published data on pregnancy outcomes at early, full, late and post term gestation in our set up. Many women would want to know their management options once at term. Evidence based information on the outcomes of pregnancy at the various gestations at and beyond term in our setting especially in relation to morbidity and mortality involved is important and will aid when counseling them on the various management options available with risks versus benefits of each with the aim being achievement of a positive pregnancy outcome. Objective: To compare the pregnancy outcomes in women who delivered between 37 0/7 and 40 6/7 weeks gestation to those who delivered at 41 0/7 weeks and beyond at Kenyatta National Hospital between 2017 and 2019. Methodology: A comparative cross sectional study was conducted at Kenyatta National Hospital for women who delivered at the maternity unit at a gestation of 37 0/7 weeks and beyond between January 2017 and December 2019. The files of 278 women, 137 who delivered at a gestation of 37 0/7 - 40 6/7 weeks and 141 who delivered at 41 0/7 weeks gestation and beyond were retrieved and data was extracted from their files. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 25. Socio-demographic characteristics, perinatal outcomes, and maternal outcomes that were categorical were summarised and presented as frequencies and proportions, while those that were continuous were presented as means with standard deviations. Comparisons of the socio-demographic and obstetric characteristics, perinatal outcomes as well as maternal outcomes between the two groups were analysed using Chi-square test and logistic regression at 95% confidence interval. A p-value < 0.05 was considered significant. Results: 278 women, 137 who delivered at a gestation of 37 0/7 - 40 6/7 and 141 who delivered from 41 0/7 weeks gestation, were evaluated using their case records and their outcomes compared. Socio demographic and obstetric characteristics were comparable between the two groups. After adjusting for socio demographic characteristics, participants who delivered at 41 0/7 weeks of gestation and beyond compared to those who delivered at 37 0/7 - 40 6/7 weeks gestation were 3.17-fold (95% CI=1.86-5.41) more likely to undergo induction of labour (P<0.01) and 2.89-fold (95% CI=1.54-5.42) more likely to deliver via a caesarean section (P<0.01). Birth weight was significantly higher when patients delivered at 41 0/7 weeks and beyond compared to 37 0/7 - 40 6/7 weeks gestation. The odds of giving birth to a baby with macrosomia compared to one with normal birth weight was 6.03-fold higher (95% CI=1.71-21.28) when delivery was at 41 0/7 weeks and beyond compared to 37 0/7- 40 6/7 weeks (P=0.005). Poor Apgar score at 5 minutes was more likely among children born at 41 0/7 weeks and beyond compared to 37 0/7- 40 6/7 [OR=6.00 (0.67-53.43)] but the difference was not statistically significant. Status of liquor, duration of labour, need for augmentation, mean blood loss irrespective of mode of delivery, intrapartum FHR, need for NBU admission and early perinatal mortality were comparable in both study groups. Conclusion and Recommendations: This study showed increased fetomaternal risks in late and post term gestations in comparison to early and full term gestations, Late and post term pregnancies were associated with increased rates of induction of labour, caesarean deliveries and macrosomia. Management of pregnancies that progress past due date should include counselling regarding risks associated with increasing gestational age. Induction of labour should continue to be offered at confirmed gestation of 41 0/7 weeks and beyond in accordance with national guidelines. Women who opt for expectant management should be monitored closely in the antepartum and intrapartum period as gestation advances.