Prolonged pregnancy Flashcards
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy. Discuss management of this patient.
History Examination Investigations Problem list Associated risks Management Side effects of misoprostol Alternate IOL methods Poor progression management Instrumental delivery requirements Advice for future pregnancies
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
History
HIV tested last
Obs hx
Fetal movements
Rest of history
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Examination
BP 150/95
Pallor
Rest of exam
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Investigations
Repeat HIV Urine dipstick Sonar CTG Hb PET bloods
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Problem list
- Primigravida
- Post-term pregnancy
- Anemia
- Hypertension
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Risks assoc with post term pregnancy
Maternal - psych stress Fetal - SB - MSL - MAS - decr cord pH - shoulder dystocia
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Management of problem list
- Admit to labour ward
- Short acting antiHT
- IOL depending on Bishop score
- 25ug every 2hrs po x 12 doses max 72hrs
- CTG before and after each dose
- stop once contractions established
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Side effects of misoprostol
Uterine rupture Nausea Vomiting Headache Dizziness Fever
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Bishop score?
Dilation Length Consistency Position Station
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Alternate IOL methods
Mechanical induction
PE2
Oxytocin and AROM
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Assess and manage poor progression of labour
Patient - psych - pain - hydration - bladder - position Power - need 3-4 contractions/10min >30s -> otherwise give oxytocin infusion Passenger - fetal size, lie, presentation, position, HR, HAB Passage - cervix, membranes, application, presenting part, pelvic size and shape
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Requirements for an instrumental delivery
Consent Analgesia Vertex Full cervical dilation No HAB No CPD Ruptured membranes Experienced operator Functional equipment
Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.
Advice for future pregnancies
Breastfeeding
Contraception options
Family spacing