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Obstetrics: Prolonged Pregnancy PP

Dr. Ishraq | Lecture 5


Prolonged Pregnancy
 Pregnancies of 294 days duration or more are defined as prolonged, post-date ,post –
 Prolonged pregnancy is associated with an increase in perinatal mortality &morbidity in
pregnancy which appear to be otherwise low risk.

Incidence of PP
 If we depend on LMP, the incidence of PP is 10%.
 If we depend on first trimester U/S, the incidence will decrease to 6%.
 PP is increase in first pregnancies, but it is not related to maternal age &the median
duration of pregnancy is 2 days longer in nulliparae compared with multiparas.
 Women with body mass index of greater than 30 are at increased risk of PP.

Aetiology of PP
1- It is likely that the majority of PP. represent the upper range of a normal distribution.
2- Genetic factor might regulate the onset of labor.
3- previos PP .The risk of PP is twice in women with previous PP compared to women with no
history of PP .
4- 4Women with male fetus has an increased risk of PP.
5- Low vaginal level of fetal fibronectin at 39 weeks are predictive of an increase likelihood of
PP, this is associated with long cervix.
6- PP could result from variation in the CRH system during pregnancy, such as alteration in
the number or expression of myometrial receptor subtypes.

Risks Associated with PP

Perinatal mortality: there is 6 folds increase in the PMR.
There is a 4 folds increase in intra-partum fetal death.
There is an increase in early neonatal death.
There is an increase in the perinatal morbidity: meconium staining liquor, meconium
aspiration syndrome, neonatal seizures, neonatal sepsis, and brachial plexus injury.
5- There is an increase in birth trauma &shoulder dystocia.

The Spikings | Page |


Antenatal Test in PP No single test is effective so combination of methods should be used.Doppler velocimetry: no benefit.U/S assessment of amniotic fluid: by measuring the largest vertical pool of amniotic fluid &used as a 1 cm pool depth as the cut –off for intervention. 3.Increase incidence of birth trauma &shoulder dystocia which in turn lead to increased incidence of perineal injury &post –partum haemorrhage.Increase incidence of dystocia (prolonged labor).3Cardiotocography: studies have reported very low rates of perinatal loss in high risk pregnancies monitored in this way.First trimester U/S is associated with lowest rate of PP.Fetal movement counting: this test does not reduce the incidence of intrauterine fetal death in late pregnancy.1-U/S to establish accurate gestational age: This is to reduce the cases of PP .Increase incidence of operative interventions i. Management 1. 2.The more complex method of monitoring .e. Women with risk factors should be offered induction at 40 weeks. 5. this test has poor sensitivity &specificity.Biophysical profile :no sufficient data to show that the biophysical profile is better than any other form of fetal monitoring . Women with uncomplicated pregnancy should be offered induction of labor beyond 41 weeks. 4. 2. 2. The increase was equally due to failure to progress &fetal distress.Obstetrics: Prolonged Pregnancy PP Dr. 1.Active management: induction of labor. I have been found that maximum pool depth performed better than AFI in predicting adverse outcome in post-term pregnancy. but doesn't improve pregnancy outcome. the more likely to yield an abnormal result. caesarean section was significantly more common with PP. This was subsequently modified to 2 cm to improve detection of growth retarded infant. 3. Ishraq | Lecture 5 2012 Matertnal Risks 1. Vaginal examination is performed &this could be accompanied by The Spikings | Page | 2 . Women should informed that there is a small increase in risk associated with continuing pregnancy beyond 41 weeks. Routine induction at 40 weeks would not considered a realistic option for prevention of post-term pregnancy. However.

women who decline induction of labor should be offered increase antenatal monitoring. Those with unfavorable cervix. ripening with prostaglandin should be done. For women who have previously delivered vaginally & for women with favorable cervix.CONSERVATIVE MANAGEMNET  From 42 weeks. method of induction .Membrane sweeping reduces the need for formal induction of labor . 3. cervical ripeness . THE END The Spikings | Page | 3 . consisting of a twice weekly CTG &U/S estimation of maximum amniotic pool depth.  For a patient with a previous caesarean section . induction of labor is unlikely to be a difficult process.The vaginal examination allows the obstetrician to inform the women of the likely ease &success of induction of labor.induction of labor is not contraindicated but associated with increased risk of scar dehiscence compared with a spontaneous onset of labor especially with prostaglandins are used. irrespective of parity . Ishraq | Lecture 5 2012 sweeping of the membranes. provided women are warned about the discomfort associated with this & are agreeable to proceed. Effects of induction of labor on the risk of caesarean section  Induction of labor for post-term pregnancy does not increase the caesarean section rate .Obstetrics: Prolonged Pregnancy PP Dr.