Post-Dated Pregnancy

Question 1

what is prolonged pregnancy?

Answer 1

• 10% of pregnancies reach 42 weeks
• Pregnancy is prolonged if ≥ 42 weeks
• Aetiology is unknown
• Increased perinatal mortality and morbidity
• Previous prolonged pregnancy/nulliparous women • Rare in South Asian/black women

Question 2

Risks of prolonged pregnancy

Answer 2

Rate of still birth – • 0.35 at 37weeks • 2.12 at 43 weeks
• Fetal distress
• Meconium passage • Neonatal illness
• Encephalopathy

Question 3

Management of the prolonged pregnancy

Answer 3

• Check the gestation carefully
• Counsel patient carefully
41 weeks-
• Examine the patient vaginally and offer induction unless patient wants to wait
• If no induction- sweep cervix and arrange daily CTG
• CTG abnormal- deliver by LSCS
• By 41-42 weeks induction of labour prevents one fetal death for every 500 women induced
• And is associated with lower caesarean section rate

Question 4

Outline the Bishop score

Answer 4

• Each component is score from 0-3 and total score is taken to decide mode of induction of labour
• Cervical dilatation
• Cervical effacement
• Cervical position – anterior/posterior/mid position
• Station of presenting part in relation to ischeal spines
• Consistency of cervix-soft/firm/medium

Question 5

Indications for induction of labour

Answer 5

• Labour is started artificially
• Indications-
Fetal indications-
• Prolonged pregnancy • IUGR
• APH
• Poor obstetric history • PROM
Materno-fetal indications-
• Pre-eclampsia and diabetes • Maternal indications-IUD
Social reasons

Question 6

Contraindications for induction of labour

Answer 6

• Placenta previa
• Abnormal CTG
• Pelvic obstruction
Relative contractions-
• One pre caesarean section • Prematurity

Question 7

Methods of induction of labour

Answer 7

Medical-
• Prostaglandins
• Oxytocin
Methods of induction
• Surgical- Amniotomy
• Combined- Artificial Rupture of Membranes (ARM) followed by Oxytocin drip
• Mechanical-Foleys catheter – Grand multip/with pre LSCS

Question 8

Methods of Natural induction of labour

Answer 8

• Cervical sweeping –pass a finger through the cervix and stripping between the membranes
• Monitoring-
• Mother should be closely monitored for hyperstimulation
• Fetus – should be monitored by CTG

Question 9

Complications of induction of labour

Answer 9

• Hyperstimulation - terbutaline
• PPH
• High risk of instrumental delivery/caesarean section