Prolonged Pregnancy Overview
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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?

<p>Membrane sweeping is used as an induction method to help stimulate labor and may have no associated risks.</p> Signup and view all the answers

Why is accurate dating important in pregnancy?

<p>Accurate dating is essential to assess fetal growth and development, and to make informed decisions about labor and delivery.</p> Signup and view all the answers

What are the maternal risks associated with prolonged pregnancy?

<p>Increased risk of operative delivery and maternal anxiety.</p> Signup and view all the answers

How does induction of labor affect caesarean section rates?

<p>Induction of labor is associated with lower caesarean section and operative vaginal delivery rates.</p> Signup and view all the answers

What is the recommended management for women who decline labor induction at term?

<p>A program of fetal surveillance should be instituted.</p> Signup and view all the answers

What are some indicators for delivery in prolonged pregnancies?

<p>Reduced amniotic fluid, reduced fetal growth, and non-perfect CTG results.</p> Signup and view all the answers

What role does continuous electronic fetal monitoring play in labor for prolonged pregnancies?

<p>It is recommended to monitor high-risk conditions, especially with meconium stained liquor.</p> Signup and view all the answers

Define prolonged pregnancy and its duration.

<p>Prolonged pregnancy is defined as pregnancy that has progressed beyond 42 weeks or 294 days from the last menstrual period (LMP).</p> Signup and view all the answers

What benefits are associated with membrane sweeping at term?

<p>Reduced duration of pregnancy and decreased frequency of pregnancies extending beyond 41 and 42 weeks.</p> Signup and view all the answers

What is the incidence of prolonged pregnancy and how does early pregnancy dating affect it?

<p>The incidence of prolonged pregnancy is 3-10%, and early pregnancy dating by ultrasound reduces the need for labor induction.</p> Signup and view all the answers

At what gestational age should women receive information about prolonged pregnancy risks?

<p>At the 38-week antenatal visit.</p> Signup and view all the answers

What is the complication associated with hypoxia and acidosis during labor?

<p>These conditions are particularly undesirable in the presence of meconium stained liquor.</p> Signup and view all the answers

Describe post maturity syndrome and its key characteristics.

<p>Post maturity syndrome resembles intrauterine growth restriction and is characterized by meconium-stained amniotic fluid, oligohydramnios, fetal distress, and dry cracked skin.</p> Signup and view all the answers

List at least two fetal risks associated with prolonged pregnancy.

<p>Increased perinatal mortality and fetal distress are two significant risks associated with prolonged pregnancy.</p> Signup and view all the answers

What factors might contribute to the likelihood of a prolonged pregnancy occurring again?

<p>Women with a history of one previous prolonged pregnancy have a 30% recurrence risk, which increases to 40% after two prolonged pregnancies.</p> Signup and view all the answers

Identify two potential physical factors that can lead to prolonged pregnancy.

<p>Hormonal factors and genetic predisposition are two physical factors that can contribute to prolonged pregnancies.</p> Signup and view all the answers

Explain why accurate dating is vital in managing prolonged pregnancies.

<p>Accurate dating is essential to determine the appropriate timing for interventions and to reduce complications associated with prolonged pregnancies.</p> Signup and view all the answers

What signs may indicate decreased fetal movement in a pregnant woman?

<p>Signs of decreased fetal movement may include reduced kicks, fewer rolls, or general lethargy in fetal activity.</p> Signup and view all the answers

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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Prolonged Pregnancy PDF

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.

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