Post term pregnancy at teaching hospitals in Addis Ababa, Ethiopia

OBJECTIVE: To Determine pregnancy outcome between term and post term deliveries and to assess the proportion of post maturity syndrome among neonates in the two groups. DESIGN: Cross-sectional comparative study of pregnancy outcome among term and post term mothers. SETTING: Two teaching hospitals in Addis Ababa, Ethiopia. SUBJECTS: 376 post-term mothers compared to 376 term mothers. MAIN OUTCOME MEASURES: Fetal distress, caesarean section rates, neonatal intensive care unit admission, perinatal mortality, congenital anomalies, low birth weight, Apgar scores, macrosomia and third stage complications. RESULTS: The proportion of mothers delivering post term at the study sites was 8.8%, which agrees with most series in which diagnosis of post term was based on LNMP. There were 99 (26.3%) fetal distress in the post term group compared to 50 (11.2%) among term deliveries (P<0.001). The caesarean rate for the post term mothers was 89 (23.7%) compared to term mothers of 47(12.5%) (P<0.001). Neonatal intensive care unit admission rate for post term mothers was 25(6.7%) compared with 1(2.9%) term mothers (P<0.05). No significant differences in the rates of perinatal mortality, congenital anomalies, low birth weight, macrosomia, CPD or third stage complications were observed between the two groups, though most were relatively frequent in post terms. CONCLUSION: Due to lack of antenatal care and late referral, the diagnosis of post terms is based on LNMP alone in most cases. Fetal distress, perinatal asphyxia and consequent caesarean delivery rate is much higher than other series. Health education on early initiation of antenatal care as well as timely referral from peripheral units is urgently needed. Based on the findings of our study we recommend that in all pregnant women (individualization is possible) with 42 completed weeks of gestation, the pregnancy should be terminated be it through vaginal or abdominal route for a better fetal outcome.