Prolonged pregnancy

Question 1

What is prolonged pregnancy?

Answer 1

A pregnancy which persists up to and beyond 42 weeks gestation

Question 2

List the risk factors for prolonged pregnancy

Answer 2

Nulliparity
Maternal age >40
Previous prolonged pregnancy
FH of prolonged pregnancy

Question 3

What is the primary concern with any prolonged pregnancy?

Answer 3

Increased risk of still birth (rises exponentially after 37/40 gestation)

Question 4

List some other complications of prolonged pregnancy

Answer 4

Increased potential for placental insufficiency

Higher risk of foetal acidaemia and meconium aspiration in labour

Increased need for instrumental and caesarean delivery

Reduced oxygen and nutrient transfer due to placental degradation can deplete foetal glycogen stores - neonatal hypoglycaemia

Question 5

List some clinical features of prolonged pregnancy

Answer 5

Static growth or macrosomia
Oligohydramnios
Reduced foetal movements
Presence of meconium
Dry/flaky skin with reduced vernix

Question 6

How is the diagnosis of prolonged pregnancy made?

Answer 6

Based on gestation
Dating is recommended between 11 to 14 weeks gestation

Ultrasound scan to check growth, liquor volume and dopplers are frequently performed in women with prolonged pregnancy

Question 7

What is a differential of prolonged pregnancy

Answer 7

Inaccurate dating

Question 8

Describe the management for prolonged pregnancy

Answer 8

Membrane sweeps from 40 weeks in nulliparous women and 41 weeks in parous women

Induction of labour - usually offered between 41 and 42 weeks gestation

Question 9

What should be offered to women who decline induction of labour?

Answer 9

Twice weekly CTG and USS with amniotic fluid measurement to identify foetal distress