Prolonged pregnancy 2011Dr K WaqanisauO&G DeptCWM Hospital1Introduction Prolonged pregnancylonger than 42 weeks / 294 days from LNMP* Post Datismlasting beyond the EDD (40 weeks)5 10% of all pregnancy will continue to at least 42 weeks* WHO Definition2Perinatal outcome3Relation to gestational age

4Relation to gestational age

5Perinatal mortality Rate 40 weeks = 2 -3 per 1000 42 Weeks = x 2 44 Weeks = x 4 - 6

Hollis B. Prolonged pregnancy. Curr Opin Obstet Gynecol 2002;14:203-7.6Prevention of post date78Accurate Dating * - ALSO course syllabus 2000 2001 ^ - SOGC CPG Sept 2008

USScanCRL = 8 13 weeks +/- 5 days*Biparietal diameter (BPD) = 12-20 weeks +/- 1 week, BPD at 20-30 weeks +/- 2 weeksBPD after 30 weeks +/- 3 weeksTranscerebellar Diameter The diameter in millimeters corresponds to weeks of gestation up to 24 weeks. The scan is more accurate if 2 or more parameters^

9Sweeping Membrane Benefits10% will achive labour in 7 hrs *Decr syntoMore NVDDecr PT No trial on 1x or multiple Most women find it very painful ^ NNT is 8 to avoid 1 IOL ^

Theoretical RisksPROMAPHChorioamnionitisEffectiveNulliprious WomenLow Bishop Score

- * McColgin SW, Parturitional factors associated with membrane stripping. Am J Obstet Gynecol 1993;169:717. ^ de Miranda E Membrane sweeping and prevention of post-term pregnancy in low-risk pregnancies: a randomized controlled trial. BJOG 2006;113:4028.10Nipple stimulation No evidence11Induction vs Expectant 12EvidenceThere was only 19 trials from RCT from 1969 2005The Canadian multicentre post term pregnancy 1992They were all under powered in detecting perinatal outcome

13Canadian multicentre post term pregnancy (CMPPT)Enrolled 3407Focused on IOL @ 41 weeks and expectant till 44 weeks or Obstetric indicationResultsCS was significant in the expectant group due to Fetal distressNo Difference in perinatal outcome2 SB in the expectant groupMost of the other trials and meta had more PMR in the expectant NNT to Induce to save 1 CS is 3014Fetal Surveillance15Types Evidence FKC NST CST CCTG BPPModified BPP No RCT on the Freq 1 RCT on the typeAlfirevic et al. 1995Compared MBPP with the other Fetal monitoring toolThere were no difference in out come in the typeBut significant reduction in Fetal distress if started @ 4116Summary17Society of obstetrician and Gynaecologistof CanadaAccurate DatingOffered the option of membrane sweeping commencing at 38 to 41 weeks, following a discussion of risks and benefits. Offered induction at 41+0 to 42+0 weeksAntenatal testing used in the monitoring of the 41- to 42-week pregnancy should include at least a MBPPEach obstetrical department should establish guidelines dependent on local resources for scheduling of labour induction.

Development is in the risk stratifying and not just GA18