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Obstetrics > Prolonged Pregnancy > Flashcards

Prolonged Pregnancy Flashcards

1
Q

What percentage of pregnancies continue past 42 weeks?

A

10%

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2
Q

What percentage of pregnancies extend past 43 and 44 weeks?

A
  • 43 weeks-3%

- 44% weeks-1%

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3
Q

What are the two dangers associated with prolonged pregnancy?

A
  1. Macrosomia

2. Placental insufficiency leading to intra-uterine death

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4
Q

What is the definition of a term pregnancy?

A

It is a pregnancy between 37 weeks and 42 weeks

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5
Q

What is the definition of a prolonged pregnancy?

A
  1. Any gestation past 42 weeks or 294 days
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6
Q

What is a post-dates pregnancy?

A

It is a pregnancy passing the date of expected delivery

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7
Q

What are the risk factors that can predispose a patient to prolonged pregnancy?

A
  1. Primigravida
  2. Previous prolonged pregnancy
  3. Obesity
  4. Deficiency in fetal adrenal cortisol production
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8
Q

When does the amniotic fluid volume start to decrease?

A

36 weeks because the blood flow is diverted to the brain and heart and less to the peripheral limbs and kidneys which leads to oliguria

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9
Q

What are the problems associated with oligohydroamnios?

A
  1. Cord compression

2. Increased meconium content

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10
Q

What are the signs of fetal dysmaturity as a result of oligohydroamnios?

A
  1. Loss of subcutaneous fat
  2. Dry, cracked skin
  3. Meconium staining of the amniotic fluid and skin
  4. A lot of scalp hair
  5. Long nails and well developed palmar creases
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11
Q

When should we induce the pregnant women?

A

At 41 weeks

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12
Q

What is the biggest risk to the baby?

A

The intra-partum period or the neonatal period because of meconium aspiration and asphyxia neonatal deaths

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13
Q

What do we do for women that are 41 and beyond with certain gestational age?

A
  1. We usually induce labour

2. Sweeping the membranes is also an option

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14
Q

What do we do for women that are 42 and above BUT UNCERTAIN gestational age?

A
  1. Monitor foetal movements
  2. Antenatal foetal heart monitoring
  3. Amniotic fluid monitoring weekly by ultrasound
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15
Q

Whilst we are observing the mom that is >42 weeks with uncertain dates we notice that the antenatal foetal heart monitoring and amniotic fluid volume is decreased
What should we do?

A

We have to terminate the pregnancy

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16
Q

Whilst we observing the baby’s foetal heart monitoring, we notice decelerations and prolonged periods of decreased variability (>60 minutes)
What is the next step?

A

C/s

17
Q

What is the amniotic fluid index(AFI)?

A

It is measured with ultrasound, where the uterus is divided by 4 quadrants and the vertical diameters are measured and added
-a AFI of <3cm or >5cm has a adverse perinatal outcome

18
Q

If there is meconium presents on delivery what should we do?

A

With the fetal head out and the trunk still in the maternal pelvis, we usually a suction the oropharynx and the nasopharynx

19
Q

When out comes to inducing labour and delivery

What do we do for patients that have a favourable cervix and a reassuring antenatal foetal measurement?

A
  1. Artificial rupture of membranes

2. Then give oxytocin IV infusion

20
Q

What do we do for patients that have unfavorable cervix

A
  1. We first have to ripen the cervix chemically or mechanically
21
Q

What should we do if we still do not achieve a ripened cervix after using the chemical or mechanical agents of induction?

A

We try again 2-3 days later

22
Q

What should we do if we are not able to get cervical ripeners?

A
  1. Monitor antenatal foetal heart
  2. Monitor amniotic fluid level
  3. Monitor regular fetal movements
    Until ripeness occurs and refer appropriately
23
Q

What should we do with baby above 4500g?

A

C/s

24
Q

What is the intra-partum management for prolonged pregnancy patients?
These being both certain or uncertain dates

A
  1. Go to hospital-as soon labour begins
  2. CTG-to observe variability and exclude decelerations
  3. Amniotomy performed
  4. Amino-infusion if necessary
  5. Continuous electrical foetal heart rate monitoring
  6. Progress in labour documented
  7. If there’s an ominious CTG with thick meconium=deliver immediately
  8. anticipate shoulder dystocia
25
Q

What are the maternal complications of prolonged pregnancy?

A
  1. Prolonged labour
  2. Anxiety
  3. Operative delivery
  4. Birth trauma due to large baby
26
Q

What are the fetal complications of prolonged pregnancy?

A
  1. Foetal distress
  2. Foetal death
  3. Macrosomia-shoulder dystocia, cephalo-pelvic disproportion and birth injuries
  4. Congenital malformations-trisomy 18, anencephaly
27
Q

What are the neonatal complications of prolonged pregnancy?

A
  1. Birth asphyxia
  2. Respiratory distress
  3. Hypoglycaemia
  4. Hypothermia
  5. Hypoxic ischaemic encephalopathy-convulsions and possible death
  6. Polycythaemia

Obstetrics (18 decks)

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