Clinical examination for identifying low-risk pregnancies suitable for expectant management beyond 40–41 gestational weeks: maternal and fetal outcomes

Abstract

Purpose: There is an ongoing discussion on whether the benefits of term elective labor induction outweigh its potential risks. This study evaluated the utility of a comprehensive clinical examination in identifying low-risk pregnancies suitable for expectant management beyond gestational age 40‒41 weeks and compared their outcomes with earlier labor induction by indication. Methods: Pregnant women (n = 722) with ≥ 40 + 0 gestational weeks referred to a tertiary hospital were included in this prospective cohort. The study population was divided into the primary induction group (induction before 42 + 0 gestational weeks) and the expectant management group (spontaneous labor onset or induction at 42 + 0 gestational weeks), by decision based on a primary consultation. The Chi-square test and logistic regression were applied. The outcome measures were composite adverse fetal outcome (admission to a neonatal intensive care unit, metabolic acidosis, or Apgar score < 7 at 5 min), treatment with intrapartum antibiotics, intrapartum maternal fever ≥ 38 °C, intrapartum cesarean section, and postpartum hemorrhage ≥ 1500 ml. Results: The main outcome measures did not differ significantly between the primary induction group (n = 258) and the expectant management group (n = 464): composite adverse fetal outcome (OR = 2.29, 95% CI = 0.92–5.68; p = 0.07), intrapartum cesarean section (OR = 1.00, 95% CI = 0.64–1.56; p = 1.00), postpartum hemorrhage ≥ 1500 ml (OR = 1.89, 95% CI = 0.92–3.90; p = 0.09), intrapartum maternal fever ≥ 38 °C (OR = 1.26, 95% CI = 0.83–1.93; p = 0.28), or treatment with intrapartum antibiotics (OR = 1.25, 95% CI = 0.77–2.02; p = 0.37). Conclusion: A comprehensive clinical examination at 40‒41 gestational weeks can identify pregnancies that might be managed expectantly until 42 gestational weeks obtaining similar outcomes to those induced earlier.