Post-maturity/ and Maternal Collapse

Question 1

What is prolonged pregnancy?

Answer 1

Exceeding 42 weeks of gesstation

Question 2

What are risk factors for prolonged pregnancy?

Answer 2

Nulliparity
Maternal age > 40
Previous prolonged preganncy
High BMI
FHx of prolonged pregnancy

Question 3

What are problems with prolonged pregnancy?

Answer 3

Intrapartum deaths 4x more common
Early neonatal deaths 3x more common
Increased rates of IOL and operative delivery
Possible placental insufficiency
Macrosomia
Shoulder dystocia
Fetal injury
Fetal skull more ossified
Increased meconium passage in labour
Fetal distress in labour
Increase C-section rates

Question 4

What is management for prolonged pregnancy?

Answer 4

Confirm EDD

At 38 weeks, discus membrane sweep and IOL if spontaneous labour does not occur by 41 weeks

Question 5

What is membrane sweep? When is it offered?

Answer 5

On vaginal examination, as much membrane is swept from the lower segment as possible by a finger inserted through the cervix.
Though to induce natural prostaglandins

Offer at 40+0 in nulliparous and 41+0 in parous women

Question 6

What is IOL? When is it offered?

Answer 6

Vaginal prostaglandin followed by oxytocin

Offer between 41+0 to 42+0

Question 7

What is management if women decline IOL?

Answer 7

Offer twice weekly CTG and US estimation of amniotic fluid depth to identify fetal distress

Doppler studies of the cord blood flow may be used for absent end diastolic flow as a predictor of fetal compromise

Question 8

What are signs of post maturity in baby?

Answer 8

Dry, cracked, peeling skin
Decreased subcutaneous tissue
Scaphoid abdomen
Meconium staining of nails and cord

Question 9

What are obstetric causes of maternal collapse?

Answer 9

Massive obstetric haemorrhage
Eclampsia
Intracranial haemorrhage
Amniotic fluid embolism
Uterine inversion causing neurogenic shock
Post-surgical haemorrahge
Severe sepsis
Peripartum cardiomyopathy

Question 10

What are non-obstetric causes of maternal collapse?

Answer 10

Massive PE
Pre-existing cardiac disease
Anaphylaxis
Stroke
Meningitis
OVerdose
DKA
Hypoglycaemia
MAlaria

Question 11

How do you manage maternal collapse?

Answer 11

A - open with head tilt chin lift
B - chest movement and breath sounds
C - carotids, BP, CPR if pulse absent
After 20 weeks CPR in left lateral position
After 20 weeks if no return of spontaneous circulation after 5 mins, LSCS
FBC, U&E, LFT, coagulation, uric acid, G&S, Crossmatch, CTPA
D - check drugs, BM, GCS
E - bleeding