Objective: to study the physiopathological, clinical and therapeutic aspects of post-term pregnancies at the gynecology and obstetrics unit of the provincial general hospital of Jason Sendwe

Materials and Method: it concerned a retrospective observational study with a comprehensive convenient sampling carried out within a period of 3 years going from January 2018 to December 2021. Inclusion criteria to the study concerned registered pregnant women with a gestational age greater than or equal to 42 weeks of amenorrhea with a complete exploitable partogram. Collected data were recorded and analyzed by Microsoft office 2016 and Epi Info 7.2.0.1.

Results: during the study period, 61 cases of post-term pregnancies were registered on a total of 2100 childbirths. Yet, only 54 cases responded to our inclusion criteria of which the results follows. The mean age of our sample study was 27.04 years. The age range of [21-24] and [31-35] years mainly represented 25.93% both. 68.52% of the pregnant women were not followed-up for their pregnancies. Most post-terms were observed in the population of multigestes/multiparous (38.89%/29.63%) and primigestes/primiparous (33.33%/27.78%) respectively. Among the sample study, 48.15% underwent an artificial induction of labor. We recorded 12.96% of neonatal death among our population sample during study period.

Conclusion: A relatively increased neonatal mortality of 12.96% was recorded in the post term gestations with 16.66% of the new born admitted to intensive care at birth, evidence that gestational advanced age is a risk factor for perinatal morbidity and mortality increases.

A post-term pregnancy is one that extends beyond 42 weeks of amenorrhea. That is 294 days from the first day of the last menstrual period [1, 2]. Besides, this theoretical definition is imprecise. Two principal variable factors have been identified during its outcome: early ultrasound dating of pregnancies and the evolution of induction practices [3]. Moreover, in accurately dated pregnancies, the cause of post term pregnancy is usually unknown. The reported frequency of post term pregnancy is approximately 7% [14]. Yet, the incidence of post term pregnancies is greatly heterogeneous in Europe and in the USA and varies between 0.5% to 10

The study carried out was a retrospective observational study undergone from January 1st 2018 to December 31st 2020 either a period of 3 years. We proceeded by an exhaustive convenient sampling of our participants to the study that targeted pregnant women admitted during study period at the provincial reference hospital of Jason Sendwe. The study sample concerned all pregnant women admitted in the unit service of gynecology for childbirth. 

Inclusion criteria: were included to the study all registered pregnant women with a gestational age more than or equal to 42 weeks of amenorrhea [1, 2] admitted at the Jason Sendwe hospital for childbirth with a complete exploitable partogram. 

Exclusion criteria: the files of the sample population with incomplete or non-exploitable partogram. 

Protocol: we used a counting premade form to collect data from the registers of childbirth in the maternity of the gynecology and obstetrics unit. Studied collected variables concerned mainly sociodemographic, clinical, therapeutic and evolutive characteristics. Collected data were recorded and analyzed respectively by the Microsoft office 2016 and Epi Info 7.2.0.1 soft wares that enabled us to generate distribution tables, frequencies and graphs. The results obtained are presented in tables and figures below.

Frequency of post term cases 

The provincial reference hospital of Jason Sendwe registered 2100 childbirth during study period among which 61 of them where post term cases. Yet seven files were excluded from study because incomplete and non-exploitable. The description of sociodemographic, clinical, therapeutic and evolutive characteristics focused on the remaining 54 retained files either a frequency of 2.57% of post term cases.

Sociodemographic characteristics

The mean age of the sample was 27.04 years with a great representation of the age range of [21-24] and [31-35] years giving a frequency of 25.93% respectively. The most represented profession was that of housewife with 50% against 7.41% civil servant representation. On the other hand, 68.52% of the newborn babies were of the male sex.

Clinical characteristics

Among the different modes of admission, pregnant women with direct admission from the reception of the hospital represented 77.77% of the overall registered sample. Only 11.11% of the pregnant women realized more than 4 prenatal consultations against 68.51% of the sample who never followed a prenatal consultation throughout their gestational period. A number of 47 pregnant women knew their date of last menstrual period either 87.03%. Besides, 22.23% of the sample population had medical past history. We equally noticed that, multigravida were mainly represented with a frequency of 38.88% followed by primigravida with 33.33%. Moreover, differences among rates exist, 29.62% multiparous and 27.77% primiparous with prolonged pregnancies. On the other hand, the Bishop score was in favor of labor induction at 51.8%.

Table 2: Clinical Characteristics of The Pregnant Women

Signs of post maturity and placenta calcification

Mainly all the recorded signs of post maturity were represented by a dry and wrinkled skin followed by elongation of appendages with 46.29% and  12.96% respectively. The cases of placenta calcification represented 48.15%.

Therapeutic characteristics

Mode of entry into labor was both artificial and spontaneous. Artificial induction of labor was realized in the group of 23 women with a frequency of 42.5% against a spontaneous labor process in 51.8% of the sample. 
Means used mostly for labor induction was oxytocin infusion in 69.5% of the cases. Vaginal delivery both for spontaneous and artificial induction was observed at 90.74%.

Table 3 : Therapeutic Characteristics

Evolutive characteristics

Postpartum complications were dominated by hemorrhagic delivery (75%) followed by cervical lesions (25%).

Figure 2: Distribution Following Post-Partum Complications

Neonatal resuscitation was observed in 16.67% of the overall birth deliveries.

Figure 3: Distribution Following Neonatal Resuscitation

Study outcome recorded 12.96% of neonatal death amongst which all of the neonatal death concerned the newborns admitted at the intensive care unit, either 77.78% of the admissions. 

Figure 4: Distribution of Neonatal Death

On a total of 2100 births during study period, 54 cases of post term pregnancies were recorded with a frequency of 2.57%. This frequency is found within the intervals of the literature that varies between 0.5 and 10% in Europe and in the USA [3]. Besides, the frequency observed during this study was less than that obtained by Moussa tangara [4] in 2015 in a study carried out in Bamako where the frequency obtained varied between 3.63% and 4.72%. The low level of instruction of the sample population (50%) may probably be a cause to this reduced rate of prenatal consultations (68.51%) and the ignorance of the date of last menstrual period which is an important element of gestational dating. On the other hand, the increase rate of corona virus pandemic from 2019 to 2020 with lockdown states may probably explain this reduced frequency of participation.

For Beisher [7], there exist a conversely proportional relationship between the mother age and the incidence of prolonged pregnancies. Mary E. Hannah [17] observed an inverse correlation of the last in a similar study. Pierre et al. [5] concluded that maternal age doesn’t influence the incidence of post term pregnancies. The age groups of 21 to 24 years and 31 to 35 years constituted 25.93% of the study sample respectively. Mohamed [12] obtained in a study a predominant age group of 20 to 30 years that correspond to the period of maximal genital activity. Obtained results from this study corroborate with those of Mohamed and confirms that the outcome of post term pregnancies is observed mainly during this age range of genital activities. It emerges from this study that, housewives were greatly represented with a frequency of 50%. These housewives for the most were illiterate without any knowledge of their late date of menstrual period added to the non-observance of prenatal consultation. Terzibachian and Benachi 15, 16] suggested that an elevated socioeconomic level may favor the prolongation of pregnancies due to a better rest observance. Yet, our results draws near to that of Moussa Tangara [4] who obtained 58% of housewives in his study and established a correlation with post term pregnancies.

More than half of the sample population either 68.51% didn’t attended prenatal consultations. This may corroborate with prolonged pregnancies as indicated by Moussa Tangara [4] where he established in his study and obtained that 79% of the pregnant women with post term pregnancies did not attended any prenatal consultation. The bishop score was favorable for labor induction in 51.8

Study reveals that, most of the participants to the study were housewives (50%) amongst which the majority either 68.51% of them didn’t underwent prenatal consultations. Bishop score was favorable for labor induction in 51.8%. Prostaglandins (30.76%) and oxytocin in infusion (69.5%) were used for labor induction in women with unfavorable cervices. Maternal risks are mainly related to caesarian section due to increased number of macrosomes or fetal distress during the last month of pregnancy. The frequency of overall post caesarian complications was 14.81% and 16.66% of the new born were admitted after birth to intensive care unit. Among the intensive care unit admissions, 77.78% of neonatal death was recorded giving a relatively increased neonatal mortality of 12.96% in the post term gestations for the overall sample of study. Evidence that the management of newborns admitted at the intensive care unit and gestational advanced age is a risk factor for perinatal morbidity and mortality increases.