Abstract

ABSTRACT: Background: Pregnancy beyond 40 weeks is associated with maternal, fetal, and neonatal complications, such as oligohydramnios, meconium stained amniotic fluid, macrosomia, and fetal post-maturity syndrome, which put the health of the baby as well as the mother at high risk. There is also increase incidence of labor dystocia, severe perineal injury, operative vaginal delivery, and increased rate of cesarean delivery. Aim: To determine the incidence of postdated pregnancies and its fetomaternal outcome inCentral Regional Referral Hospital (CRRH), Gelephu, Bhutan. Methods: Medical records-based data (demographic details, maternal and neonatal outcome, perinatal management and complications,) of pregnant women aged 18-45 years who delivered after 40 completed weeks of gestation was collected. Duration of study was3 years (January 1st, 2018 to December 31st, 2020). Results: We determined that almost half of the women (43.5%) had postdated pregnancy, with very low incidence of post-term pregnancy (2.1%). Almost half of these women underwent induction of labor (45.5%), with misoprostol being used overwhelmingly (86.7%). A statistically significant proportion of women who underwent induction of labor at 41 weeks or more had higher incidence of cesarean section births versus those who were expectantly managed (23% vs 16.4%; p-value 0.003). Failed induction of labor in women admitted after 41 weeks of gestation significantly contributed to cesarean section as compared to less than 41 weeks (30.3% vs 15.9%; p-value 0.009). There was low incidence of adverse maternal and neonatal outcomes. Conclusion: Our study found high proportion of women with postdated pregnancy, of which majority of whom underwent induction of labor. Labor induction at or after 41 weeks was associated with higher failure rate and cesarean section. There was low incidence of adverse maternal or neonatal outcome. Our findings could inform clinicians regarding the management of postdated women in Bhutanese setting.  Keywords: Postdated pregnancy, induction of labor, misoprostol, cesarean delivery, Bhutan.