Maternal and neonatal outcomes of induction of labour after 41 weeks compared with spontaneous labour beyond 40 weeks in postdated pregnancy: A prospective observational comparative study

Background: Postdated pregnancy is associated with increased maternal and perinatal morbidity due to progressive placental insufficiency, oligohydramnios, fetal compromise, and fetal macrosomia with advancing gestational age [1, 3]. The optimal timing of induction of labour in prolonged pregnancy remains an important clinical consideration. In many tertiary care institutions, induction of labour is deferred until completion of 41 weeks unless maternal or fetal indications necessitate earlier intervention. Aim: To compare maternal and neonatal outcomes between women undergoing induction of labour after 41 weeks and women entering spontaneous labour beyond 40 weeks in postdated pregnancy. Methods: This prospective observational comparative study was conducted over a period of one year in the Department of Obstetrics and Gynaecology of a tertiary care teaching hospital. A total of 200 antenatal women with singleton cephalic pregnancies beyond 40 weeks of gestation were included. The induction group consisted of 100 women induced after 41 completed weeks, while the spontaneous labour group included 100 women who entered spontaneous labour beyond 40 weeks. Maternal characteristics, Bishop score, duration of labour, mode of delivery, indications for cesarean section, maternal complications, and neonatal outcomes were compared. Statistical analysis was performed using Chi-square test and independent t-test. A p-value <0.05 was considered statistically significant. Results: The rate of vaginal delivery was comparable between the induction and spontaneous labour groups (70% vs 76%, p=0.338). Cesarean section rates were slightly higher in the induction group (24% vs 19%), though the difference was not statistically significant (p=0.392). Meconium-stained liquor was significantly more common among women entering spontaneous labour beyond 40 weeks (26% vs 18%, p=0.041). Fetal distress was more frequently observed in the spontaneous labour group. Neonatal outcomes including APGAR score and NICU admission were comparable between the groups. Maternal complications including postpartum hemorrhage and prolonged labour did not differ significantly. Conclusion: Induction of labour after 41 weeks in carefully selected women is a safe and effective intervention and does not significantly increase maternal or neonatal morbidity. Timely induction may reduce fetal complications associated with prolonged pregnancy while maintaining acceptable rates of vaginal delivery.