[13] Prolonged Pregnancy Flashcards
What is prolonged pregnancy also known as?
Post-dates pregnancy or post-term pregnancy
What is prolonged pregnancy?
Any pregnancy that progresses beyond 42 weeks gestation
What is prolonged pregnancy associated with?
Feta, neonatal and maternal complications
When do the risks associated with prolonged pregnancy increase?
Immediately after term and significantly after 41 weeks
What can be used to improve outcomes of prolonged pregnancy?
Induce labour before or at 42 weeks
What are the risk factors for prolonged pregnancy?
- Previous post-term pregnancy
- Primigravidity
- High maternal BMI
- Genetic factors
- Advanced maternal age
What signs indicate post-maturity of the baby before it is born?
- Reduced fetal movement
- Reduced volume of amniotic fluid causing reduction in uterus size
- Meconium-stained amniotic fluid when membranes rupture
What characteristic features may a prolonged pregnancy baby have on delivery?
- Dry, peeling and cracked skin particularly on hands and feet
- Absence of vernix caseosa and lanugo
- Loss of subcutaneous fat
- Meconium staining of skin
What fetal problems is prolonged pregnancy associated with?
Increased morbidity and mortality
At what stage can death occur associated with prolonged pregnancy?
- Stillbirth
- Neonatal death
- Death in first year of life
What is thought to cause the increased fetal mortality associated with prolonged pregnancy?
- Utero-placental insufficiency
- Meconium aspiration
- Intrauterine infection
What conditions does prolonged pregnancy increase the risk of?
- Meconium aspiration
- Macrosomia and larger babies
- Neonatal acidaemia
- Neonatal encephalopathy
- Neonatal seizures
- Features of IUGR
What can macrosomia lead to as a result of prolonged pregnancy?
- Prolonged labour
- Cephalo-pelvic disproportion
- Shoulder dystocia
- Birth injury
What birth injuries can occur as a result of prolonged pregnancy?
- Brachial plexus damage
- Cerebral palsy
What are the maternal risks of prolonged pregnancy?
- Obstructed labour
- Perineal damage
- Instrumental delivery
- C-section
- Postpartum haemorrhage
- Infection
What complications can occur if labour is induced for prolonged pregnancy before the cervix is in a favourable state?
- Need for c-section
- Prolonged labour
- Post-partum haemorrhage
- Traumatic delivery
When should women be offered induction for prolonged pregnancy?
After 41 weeks
What does induction before 42 weeks do to prognosis of prolonged pregnancy?
- Fewer perinatal deaths
- Fewer c-sections
What should women be offered before induction of labour?
Vaginal examination and membrane sweep
What monitoring should women receive if they refuse induction after 42 weeks?
- Twice weekly cardiotocography
- USS estimation of maximum amniotic pool depth
Why is induction of labour often difficult in prolonged pregnancy?
The cervix is often unfavourable
What Bishop’s score is normally seen in prolonged pregnancy?
< 3
What should be attempted to make the cervix more favourable for induction in prolonged pregnancy?
Prostaglandins and mechanical methods of cervical preparation
When may c-section be the preferred method of delivery for prolonged pregnancy?
- Cervical preparation fails
- Infant is large
Why is careful observation required in labour of prolonged pregnancy?
They are high risk pregnancies
