Prolonged Pregnancy Flashcards
What percentage of pregnancies continue past 42 weeks?
10%
What percentage of pregnancies extend past 43 and 44 weeks?
- 43 weeks-3%
- 44% weeks-1%
What are the two dangers associated with prolonged pregnancy?
- Macrosomia
2. Placental insufficiency leading to intra-uterine death
What is the definition of a term pregnancy?
It is a pregnancy between 37 weeks and 42 weeks
What is the definition of a prolonged pregnancy?
- Any gestation past 42 weeks or 294 days
What is a post-dates pregnancy?
It is a pregnancy passing the date of expected delivery
What are the risk factors that can predispose a patient to prolonged pregnancy?
- Primigravida
- Previous prolonged pregnancy
- Obesity
- Deficiency in fetal adrenal cortisol production
When does the amniotic fluid volume start to decrease?
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
What are the problems associated with oligohydroamnios?
- Cord compression
2. Increased meconium content
What are the signs of fetal dysmaturity as a result of oligohydroamnios?
- Loss of subcutaneous fat
- Dry, cracked skin
- Meconium staining of the amniotic fluid and skin
- A lot of scalp hair
- Long nails and well developed palmar creases
When should we induce the pregnant women?
At 41 weeks
What is the biggest risk to the baby?
The intra-partum period or the neonatal period because of meconium aspiration and asphyxia neonatal deaths
What do we do for women that are 41 and beyond with certain gestational age?
- We usually induce labour
2. Sweeping the membranes is also an option
What do we do for women that are 42 and above BUT UNCERTAIN gestational age?
- Monitor foetal movements
- Antenatal foetal heart monitoring
- Amniotic fluid monitoring weekly by ultrasound
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?
We have to terminate the pregnancy
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?
C/s
What is the amniotic fluid index(AFI)?
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
If there is meconium presents on delivery what should we do?
With the fetal head out and the trunk still in the maternal pelvis, we usually a suction the oropharynx and the nasopharynx
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?
- Artificial rupture of membranes
2. Then give oxytocin IV infusion
What do we do for patients that have unfavorable cervix
- We first have to ripen the cervix chemically or mechanically
What should we do if we still do not achieve a ripened cervix after using the chemical or mechanical agents of induction?
We try again 2-3 days later
What should we do if we are not able to get cervical ripeners?
- Monitor antenatal foetal heart
- Monitor amniotic fluid level
- Monitor regular fetal movements
Until ripeness occurs and refer appropriately
What should we do with baby above 4500g?
C/s
What is the intra-partum management for prolonged pregnancy patients?
These being both certain or uncertain dates
- Go to hospital-as soon labour begins
- CTG-to observe variability and exclude decelerations
- Amniotomy performed
- Amino-infusion if necessary
- Continuous electrical foetal heart rate monitoring
- Progress in labour documented
- If there’s an ominious CTG with thick meconium=deliver immediately
- anticipate shoulder dystocia
What are the maternal complications of prolonged pregnancy?
- Prolonged labour
- Anxiety
- Operative delivery
- Birth trauma due to large baby
What are the fetal complications of prolonged pregnancy?
- Foetal distress
- Foetal death
- Macrosomia-shoulder dystocia, cephalo-pelvic disproportion and birth injuries
- Congenital malformations-trisomy 18, anencephaly
What are the neonatal complications of prolonged pregnancy?
- Birth asphyxia
- Respiratory distress
- Hypoglycaemia
- Hypothermia
- Hypoxic ischaemic encephalopathy-convulsions and possible death
- Polycythaemia
