MANAGEMENT OF PROLONGED

PREGNANCIES

SITI NUR BAITI BINTI SHAIK KHAMARUDIN 012013100196

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OUTLINE

• How to manage?• Antepartum management

– Prognostic factors of successful induction– Overall management recommendation

• Intrapartum management • Reference

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HOW TO MANAGE? • The decision centers on whether:

– Labor induction, or– Expectant management with fetal surveillance

(waiting)• Routinely induce women at 41 weeks.• Fetal testing until 42 weeks performed

twice weekly.

3Nonstress test AFI

ANTEPARTUM MANAGEMENT

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(A) UNFAVOURABLE CERVIX

Bishop score < 7 in 80%•Women with no cervical dilatation have twofold increased cesarean delivery rate for dystocia.•Cervical length ≤ 3cm is predictive of successful induction.

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(B) CERVICAL RIPENING

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PGE2 Dinoprostone vaginal tablet

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FOLEY CATHETER

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EXTRA AMNIOTIC SALINE INFUSIONS

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LAMINARIA TENT

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SWEEPING AND STRETCHING

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(C) STATION OF VERTEX

• Studies done in 2004 on 484 nulliparas who underwent induction after 41 weeks.

• Cesarean delivery rate was directly related to station:– 6% at -1– 20% at -2– 43% at -3– 77% at -4

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MANAGEMENT RECOMMENDATION

• Not mandatory but

initiation of fetal

surveillance at 41 weeks

is reasonable.

• After completing 42 weeks,

either antenatal testing or

labor induction is

recommended.

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• Consider 41-week pregnancies without complications.

• If there are complications e.g. :a) Hypertensionb) Decreased fetal movement, orc) Oligohydramnios

Labor should

be induced

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WOMEN OF CERTAIN

GESTATIONAL AGE

•Labor is induced at week 42•90% are induced successfully or enter labor within 2 days of induction•If not deliver:

• 2nd induction within 3 days

• Unusual 3rd induction

• Induction vs LSCS

WOMEN OF UNCERTAIN

GESTATIONAL AGE

•Weekly nonstress fetal testing & assessment of amniotic fluid •AFI ≤ 5 cm or reports of diminished FM should undergo labor induction

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INTRAPARTUM MANAGEMENT

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THICK MECONIUM IN AMNIOTIC FLUID

• The viscosity probably signifies lack of fluid oligohydramnios

• Why we don’t aspirate for assessment?– May cause severe pulmonary dysfunction and

neonatal death• Hence, amnioinfusion is done during labor

– A way of diluting meconium to aspiration syndrome.

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Amnioinfusion

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FHR and uterine resting tone are assessed

IMPORTANCE • Successful SVD is reduced in

nulliparous woman who is in early labor with thick meconium-stained amniotic fluid.

• Hence if she is remote from delivery,

prompt LSCS is considered especially if:– Cephalo-pelvic disproportion– Hypotonic or hypertonic dysfunctional labor

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REFERENCE

• Obstetrics Today 2nd Edition

• Williams Obstetrics 24th Edition

• http://bmc1.utm.utoronto.ca/~amanda/visualtoolssite/postdates_basics.html

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