title: Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy.
abstract: OBJECTIVE
  To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs).
  
  
  METHODS
  Nationwide retrospective register study between 2000 and 2007.
  
  
  METHODS
  All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198).
  
  
  METHODS
  All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group.
  
  
  METHODS
  Perinatal morbidity.
  
  
  RESULTS
  In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered.
  
  
  CONCLUSIONS
  A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies.
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden. charlotta.grunewald@sodersjukhuset.se
authors.forename: Charlotta
authors.initials: C
authors.lastname: Grunewald
authors.forename: Stellan
authors.initials: S
authors.lastname: Håkansson
authors.forename: Sissel
authors.initials: S
authors.lastname: Saltvedt
authors.forename: Karin
authors.initials: K
authors.lastname: Källén
mesh_terms: D002985:Clinical Protocols; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000401:mortality* / Q000628:therapy*; D012041:Regional Medical Programs; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology