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2 Prolonged Pregnancy

Prolonged pregnancy, defined as any pregnancy lasting 42 weeks or more, has an incidence of 5% to 10% among women with singleton pregnancies. It is associated with increased perinatal mortality and various complications such as fetal distress and meconium aspiration syndrome. Management involves confirming gestational age, monitoring fetal well-being, and considering delivery based on cervical readiness and other risk factors.

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Adedamola Adegboye
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2 views16 pages

2 Prolonged Pregnancy

Prolonged pregnancy, defined as any pregnancy lasting 42 weeks or more, has an incidence of 5% to 10% among women with singleton pregnancies. It is associated with increased perinatal mortality and various complications such as fetal distress and meconium aspiration syndrome. Management involves confirming gestational age, monitoring fetal well-being, and considering delivery based on cervical readiness and other risk factors.

Uploaded by

Adedamola Adegboye
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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PROLONGED PREGNANCY

Oladapo Shittu

1
SYNONYMS & DEFINITION
•Prolonged pregnancy Pregnancy
exceeding
•Post-date pregnancy EDD

•Post-term pregnancy Any pregnancy of ≥


42 weeks (294 days)
duration

2
Postmaturity

Is a specific syndrome of an infant that is associated


with post-term/date (prolonged) pregnancy

3
Prolonged Pregnancy: Incidence

•In the absence of any medical intervention,


the incidence has been described as between
5% and 10% of women with singleton
pregnancies

4
Incidence of Prolonged Pregnancy
Depends on Mode of
Pregnancy Dating
Risk Factors
• More prevalent among
•By LMP = 7.5 % nullipara than
multipara
• Previous 1 post-term :
•By USS = 2.6 % 27 %
• Previous 2 post-term :
•By LMP + USS = 1.1 % 39 %

5
The Problem
•Epidemiological studies demonstrate that
perinatal mortality rises beyond 41w:
oDoubles at 42 weeks and
oTriples at 43 weeks but...
•There are racial and ethnic differences:
oLowest in whites
oHigher in blacks
oHighest in southern Asians

6
AETIOLOGY
•Wrong dates
•Biological - previous prolonged pregnancy.
•Irregular ovulation
•Preceding use of hormonal contraceptives,
especially the injectables
•Decreased fetal estrogen production
• Placental sulfatase deficiency
• Anencephaly
• Fetal adrenal hypoplasia
•Extra-uterine pregnancy (v.v. rare)
7
Physiological Changes Associated with
Post-term Gestation
• PLACENTAL CHANGES :
osenescence/ageing (increased grading on USS) infarcts,
calcification

• AMNIOTIC FLUID CHANGES :


oOligohydramnios (diminished fetal urination)
ocloudy (flakes of vernix)
oLecithin/Sphygomyelin (L/S) ratio = > 4:1
opresence of meconium

• FETAL CHANGES :
o 45% - Macrosomia
o 10% - Intra-uterine malnutrition
oFusion of fetal skull bones 8
Increased Perinatal Mortality may be
due to…
•“Ageing” of the placenta

•Increasing rates of meconium and consequent


meconium aspiration
• This occurs with intrauterine asphyxia

•And increased rates of C/S after 42w are for the


common reasons of:
• Fetal distress
• CPD or
• failure of progress in labour
9
Complications
MATERNAL FETAL
• Anxiety • Fetal distress
• CPD • Meconium Aspiration
• Shoulder dystocia Syndrome
• Increased C/S rate • Fetal trauma
• brachial plexus injuries,
• PPH risk • clavicle fracture
• Increased perinatal
mortality
• Dysmaturity syndrome

10
Management -1
CONFIRMATION OF GESTATIONAL AGE
1. Reliable LMP
• Date known
• No Oral Contraceptive Pill use for 3 months
• Regular cycles
2. First trimester USS, using CRL(+/-7d)
3. Second trimester USS, using BPD (+/- 14d)
4. First trimester P/V examination
5. Doppler FHT 10 wks
6. Quickening 16-18 wks
11
Management Cont ….

•USG
• Amniotic Fluid Index < 5 = oligohydramnios
(4-Quadrant Technic [8-18])
•Amniotic Fluid Depth < 2.7 = oligohydramnios
• Macrosomia (fetal weight estimation)
• Placental grading

•Vaginal examination
• Assess cervical inducibility - BISHOPS score 12
Identification of patients
that need delivery when
post-date

Ripe cervix
Unripe cx
Oligohydramnios
Normal fluid
Macrosomia
Normal NST/CST(or BPP)
Abnormal NST/BPP(or CST)
Normal fetal size
Meconium stained liquor

Cervical assessment,
NST, AFI
DELIVERY Weekly at 40 & 41 wks
Sweep membranes
Deliver at 40w + 10d

DELIVERY
13
Intrapartum Management

• Left lateral position


• Open partograph in Active 1st Stage Labour
• Continuous Pinard/electronic fetal monitoring
• Early ARM in active phase (hastens progress, detects
meconium), if not contraindicated
• C/S if CPD/macrosomia, fetal distress or poor progress
• Amnioinfusion (750-1000ml warm Normal
Saline/Ringer’s Lactate) – If meconium stained liquor,
variable decelerations – where available
• Active management of 3rd Stage of Labour
• Paediatrician involved at delivery
14
Prevention

•Sweeping/stripping of
membranes at term if no
vaginitis, malpresentation
or placenta praevia

15
Thank you!

16

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