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Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term

Objective We sought to estimate when rates of maternal pregnancy complications increase beyond 37 weeks of gestation. Study design We designed a retrospective cohort study of all low-risk women delivered beyond 37 weeks’ gestational age from 1995 to 1999 within a mature managed care organization. Ra...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2007-02, Vol.196 (2), p.155.e1-155.e6
Main Authors: Caughey, Aaron B., MD, MPP, MPH, PhD, Stotland, Naomi E., MD, Washington, A. Eugene, MD, MSc, Escobar, Gabriel J., MD
Format: Article
Language:English
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Summary:Objective We sought to estimate when rates of maternal pregnancy complications increase beyond 37 weeks of gestation. Study design We designed a retrospective cohort study of all low-risk women delivered beyond 37 weeks’ gestational age from 1995 to 1999 within a mature managed care organization. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariable analyses. Results We found that, among the 119,254 women who delivered at 37 completed weeks and beyond, the rates of operative vaginal delivery (OR 1.15, 95% CI 1.09, 1.22), 3rd- or 4th-degree perineal laceration (OR 1.15, 95% CI 1.06, 1.24), and chorioamnionitis (OR 1.32, 95% CI 1.21, 1.44) all increased at 40 weeks as compared to 39 weeks of gestation ( P < .001), and rates of postpartum hemorrhage (OR 1.21, 95% CI (1.10, 1.32), endomyometritis (OR 1.46, 95% CI 1.14, 1.87), and primary cesarean delivery (1.28, 95% CI 1.20, 1.36) increased at 41 weeks of gestation ( P < .001). The cesarean indications of nonreassuring fetal heart rate (OR 1.81, 95% CI 1.49, 2.19) and cephalo-pelvic disproportion (OR 1.64, 95% CI 1.40, 1.94) increased at 40 weeks of gestation ( P < .001). Conclusion We found that the risk of maternal peripartum complications increase as pregnancy progresses beyond 40 weeks of gestation. Management of pregnancies that progress past their EDC should include counseling regarding the risks of increasing gestational age.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2006.08.040