Podcast
Questions and Answers
What are some potential causes of fetal distress during pregnancy?
Potential causes of fetal distress include oligohydramnios, meconium-stained amniotic fluid, and inaccurate dating of the pregnancy.
How can male fetuses exhibit different characteristics compared to female fetuses?
Male fetuses may exhibit differences in hormonal and genetic traits, which can include aspects of obesity.
What is the potential impact of a placenta with downs on pregnancy management?
A placenta with downs is associated with a higher risk, requiring closer monitoring and potential interventions.
What role does membrane sweeping play in pregnancy management?
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Why is accurate dating important in pregnancy?
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What are the maternal risks associated with prolonged pregnancy?
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How does induction of labor affect caesarean section rates?
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What is the recommended management for women who decline labor induction at term?
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What are some indicators for delivery in prolonged pregnancies?
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What role does continuous electronic fetal monitoring play in labor for prolonged pregnancies?
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Define prolonged pregnancy and its duration.
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What benefits are associated with membrane sweeping at term?
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What is the incidence of prolonged pregnancy and how does early pregnancy dating affect it?
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At what gestational age should women receive information about prolonged pregnancy risks?
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What is the complication associated with hypoxia and acidosis during labor?
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Describe post maturity syndrome and its key characteristics.
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List at least two fetal risks associated with prolonged pregnancy.
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What factors might contribute to the likelihood of a prolonged pregnancy occurring again?
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Identify two potential physical factors that can lead to prolonged pregnancy.
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Explain why accurate dating is vital in managing prolonged pregnancies.
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What signs may indicate decreased fetal movement in a pregnant woman?
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Study Notes
Prolonged Pregnancy
- Definition: Pregnancy lasting beyond 42 weeks (294 days) from the last menstrual period (LMP) or established by ultrasound before 16 weeks
- Incidence: 3-10%, dependent on early pregnancy dating via ultrasound. Early dating reduces labor induction needs for prolonged pregnancies. Recurrence risk: 30% after one, 40% after two prolonged pregnancies.
Clinical Scenario
- 40-year-old woman, G6P5, with history of decreased fetal movement, 40 weeks pregnant (confirmed by LMP and 14-week ultrasound). Management options need to be discussed.
Post Maturity Syndrome
- Similar to intrauterine growth restriction
- Characterized by:
- Meconium-stained amniotic fluid
- Oligohydramnios
- Fetal distress
- Loss of subcutaneous fat
- Dry, cracked skin
- Not all post-term pregnancies have this.
Causes of Prolonged Pregnancies
- Most common cause is inaccurate dating.
- Simple biological variation can occur.
- Prolonged pregnancy is more common in first-time mothers (primigravidas).
- Recurrence risk increases with each prolonged pregnancy (27% for one prior, 39% for two prior).
- Potential contributing factors: male fetuses, hormonal factors, genetic predisposition, obesity, and fetal adrenal insufficiency/hypoplasia.
Risks of Prolonged Pregnancy (Fetal)
- Increased perinatal mortality (antepartum, intrapartum, neonatal) due to placental insufficiency
- Increased incidence of meconium staining and aspiration
Risks of Prolonged Pregnancy (Maternal)
- Increased risk of operative delivery (cesarean section or operative vaginal delivery) due to fetal distress
- Increased maternal anxiety
Management Options
- Women assessed at 40 weeks. Labor induction offered if high risk factors present (history of haemorrhage, hypertension, previous stillbirth)
- Induction of labor recommended if pregnancy extends beyond 41 weeks.
- Lower cesarean section and operative vaginal delivery rates.
- Lower risk of meconium-stained liquor.
- Cost-effective compared to expectant management.
Membrane Sweeping
- Performed routinely as a policy in term pregnancies.
- Associated with shortened duration and reduced frequency of post-41/42 week pregnancies.
- Increased incidence of discomfort (e.g. bleeding, irregular contractions).
Expectant Management
- Favourable outcome possible if labor decline.
- Fetal surveillance program (twice weekly CTG, Doppler of umbilical arteries, liquor volume assessment, BPP)
- 40-50% of women deliver 4-5 days after 42 weeks.
- Indications for delivery: reduced amniotic fluid, reduced fetal growth, reduced fetal movement, non-reassuring CTG.
Labor Management
- Labor in prolonged pregnancy is high-risk and continuous electronic fetal monitoring is recommended, especially with meconium-stained liquor or absence of liquor upon membrane rupture.
- Hypoxia and acidosis are undesirable in meconium-stained liquor cases.
Recommendations
- 38-week antenatal visit: offer information about the risks/options for pregnancies lasting longer than 42 weeks.
- Membrane sweeping reduces the need for formal labor induction in uncomplicated cases.
- Induction offered usually between 41+0 to 42+0 weeks
- Women declining induction from 42 weeks should receive increased antenatal monitoring (at least twice weekly CTG and US amniotic fluid measurement).
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Description
This quiz explores the concepts of prolonged pregnancy, its incidence, management options, and associated syndromes like post maturity syndrome. It covers clinical scenarios and causes, helping learners understand the implications of pregnancies beyond 42 weeks. Test your knowledge on this important obstetric topic.
