Swedish study highlights reduced risks from active management of prolonged pregnancy

In a recent interview with Contemporary OB/GYN, Ulla-Britt Wennerholm, MD, a professor and obstetrician-gynecologist from Sahlgrenska University Hospital in Gothenburg, Sweden, discussed the management of prolonged pregnancies through active labor.

Prolonged pregnancies, which occur after 40 weeks' gestation, are associated with increased perinatal and neonatal risks, particularly maternal complications and stillbirths. Wennerholm highlighted how active management can mitigate these risks.

The discussion drew from a Swedish randomized controlled trial, the Swedish Post-term Induction Study, which demonstrated a significant reduction in stillbirths when labor was induced at 41 weeks instead of the traditional approach of waiting until 42 weeks. The trial was cut short based on recommendations from the Data Safety and Monitoring Committee because of the cbenefits of early induction.

The study’s findings led to substantial debate and changes in Swedish medical practices. By 2021, national guidelines were introduced recommending that women be offered induction at 41 weeks or to have an individualized plan that ensures delivery by 42 weeks.

Wennerholm explained that the current study is a follow-up to the original trial, analyzing the impact of these national guidelines. This study compares outcomes from 3 years before and 3 years after the guidelines' implementation. The researchers utilized data from Sweden's comprehensive national health registers, including the Medical Birth Registry, Patient Registry, Cause of Death Registry, and Statistics Sweden. These registries allowed for a near-complete follow-up and large sample size, enabling detailed observational analysis that would be difficult to achieve through randomized trials.

The follow-up study underscored the benefits of national guidelines in reducing adverse outcomes for prolonged pregnancies through early induction or active management, emphasizing Sweden’s robust health care infrastructure for tracking and improving maternal and neonatal health outcomes.

This video is part 1 of a 2-part series. Click here for part 2.