Prolonged pregnancy management

Question 1

Define: post-term

Answer 1

Pregnancy has reached or is beyond 42-0 wks

Question 2

Define: Early term

Answer 2

37-0 – 38-6 wks

Question 3

Define: Full term

Answer 3

39-40-6 wks

Question 4

Define: Late term

Answer 4

41-0-41-6 wks

Question 5

Define:

Postmature

Answer 5

• “Postmaturity syndrome” - complicates 10–20% of postterm pregnancies
• Decreased subcutaneous fat
• Lack vernix and lanugo
• Meconium staining of the amniotic fluid, skin, mem- branes, and umbilical cord often is seen in association with a postmature newborn

Question 6

Risk factors for prolonged pregnancy

Answer 6

• Primigravida
• Prior post-term pregnancy
• Carrying male fetus
• Obesity
• Genetic predisposition

Question 7

Describe management of prolonged pregnancy

Fetal testing and surveillance techniques

Answer 7

• Evidence based for healthy person (low risk) < 40 years old →
  
  • Begin NST or BPP/AFI at 41 weeks, repeat NST in 72 hours, induce by 42 weeks
  • Risk of still birth increases with increased gestational age

Question 8

Most important prevention for preventing postterm pregnancy and its serious risks

Answer 8

Accurate pregnancy dating

Question 9

List possible methods used for cervical ripening and labor induction and the risks and benefits of each, as pertinent to informed consent:

Membranes sweeping

Answer 9

• Cervix needs to be open enough to fit a few fingers into it
• Sweeping through internal os through LUS releaseing PGAs → causes cervix to ripen
• Done on weekly basis can reduce GA by 1 week (from 36 weeks on)
• Uncomfortable for pregnant person and may see some light spotting after
• Studies show safe in GBS+ population, no studies on HIV or Hepatitis

Question 10

List possible methods used for cervical ripening and labor induction and the risks and benefits of each, as pertinent to informed consent:

Castor Oil

Answer 10

• Potent cathartic derived from the bean of the castor plant
• One of the most popular drugs for labor induction, used by worldwide (anecdotal reports dating back to ancient Egypt for use as a labor stimulant)
• Metabolite of castor oil, ricinoleic acid, activates intestinal and uterine smooth muscle cell activity stimulating the initiation of labor
• Tastes horrible, cause temporary diarrhea and abdominal cramping
• Not likely to be effective if the woman’s body is not yet physiologically ready for labor.

Question 11

List possible methods used for cervical ripening and labor induction and the risks and benefits of each, as pertinent to informed consent:

Prostaglandins

Answer 11

• Most commonly used in patients with an unfavorable cervix or a Bishop score < 6.
• Studies have shown both misoprostol (prostaglandin E1 [PGE1]) and dinoprostone (prostaglandin E2 [PGE2]) to be ther preparation is acceptable
• Don’t use in someone with prior uterine scar (?)
• Risk of uterine tachysystole (5%)

Question 12

Blue cohosh (caulophyllum) and Black cohosh

Answer 12

Dont use it during pregnancy or labor. Lots of case studies with bad outcomes (neonatal HIE, stroke, heart issues) and not enough research about safety.