Prolonged pregnancy Post term pregnancy = prolonged pregnancy

  • View
    72

  • Download
    1

Embed Size (px)

DESCRIPTION

Prolonged pregnancy Post term pregnancy = prolonged pregnancy - post maturity : describe neonate that have specific characteristics as long nails ,loose skin ,peeling of epidermis. Prolonged pregnancy increase risk of perinatal morbidity & mortality rate - PowerPoint PPT Presentation

Text of Prolonged pregnancy Post term pregnancy = prolonged pregnancy

  • Prolonged pregnancyPost term pregnancy = prolonged pregnancy - post maturity : describe neonate that have specific characteristics as long nails ,loose skin ,peeling of epidermis .

  • Prolonged pregnancy increase risk of perinatal morbidity & mortality rate .*definition of prolonged pregnancy : as pregnancy equal to or more than 42 weeks or 294 days from the 1st day of LMP .

  • * associated risks of prolonged pregnancy;@mother : 1- macrosomic infant ( shoulder dystocia )2-genital tract trauma .3-post partum hemorrhage .4-increase risk of operative birth

  • @fetus : 1- bone injury .2-soft tissue trauma .3-hypoxia .4-cerebral hemorrhage .5-still birth .

  • @neonate : 1- SGA ( small gestational age ) 2- me conium aspiration .3-asphyxia .

  • Goal : reach optimum outcome for mother & baby .

    Predisposing factors of prolonged pregnancy :

  • @previous prolonged pregnancy .@male fetus . @ null parity @body mass index of pregnancy more than 25Kg\M@anencephaly .

  • management of prolonged pregnancy consent form need to take by mother & her husband to do induction of labor .To assess fetal being do : NST :non stress test & u\s to estimate AFV by using amniotic fluid index AFI

  • CTG .-Monitor FHR with two acceleration of more than 15 seconds ,above base line in 20 minutes .Any irregularities mean non reassuring CTG .

  • * membrane sweep : -Done at 41 weeks gestation , Increase onset of spontaneous labor physiologically, to avoid use of prostaglandin ,AROM ,& oxytocin .

  • * procedure :- introducing the examining fingers into cervical os & passing them in circular way around the cervix this lead to increase secretion of prostaglandin at local area this procedure done also if cervix closed .Procedure can be repeated

  • induction of labor : IOL

    *Done at 41 weeks gestation .Used to uncomplicated pregnancy .Could be done at 42weeks gestation .Full assessment should be done .

  • * indications of IOL : 1- PIH .2- GDM.3-IUGR.4-macrosomia .5-social reason

  • @ maternal indications :* prolonged pregnancy .*HTN,PIH,according to mother symptoms .*DM ,still birth ,macrosomia .*prelabor ROM after 24hours of ROM .*maternal request ,psychological & social reason

  • .@fetal indications :*IUGR less than 34weeks .*macrosomia,decrease incidence of shoulder dystocia .*fetal death .*fetal anomaly .

  • @ contraindication of IOL ;* placenta previa .*transverse lie ( compound presentation .*HIV positive woman .* active genital herpes .*cord presentation & cord prolapse .*known case of CPD *severe acute fetal compromise.

  • @ method of induction :-favorable cervix ( dilated & effaced) .-descent of the presenting part .-before induction ,abdominal examination should be done .-use of bishop score .-transvaginal u\s to assess length of the cervix .

  • @ membrane sweep :-done after 40weeks .-carried out by Dr or midwife .-safe procedure .-it recommended to do before IOL .Side effect : - doesnt reduce the need of IOL . - cause discomfort . - irregular contraction .

  • @ prostaglandin E2( pGE2) dinoprostone :-PGE2& PGF2 normally produced by cervix ,uterus ,deciduas ,&fetal membrane .-act locally on these structure .-PGE2 vaginal tab. ,gel ,pessaries .-

  • placed in the posterior fornix of the vagina .-it absorbed by epithelium of the vagina & cervix .Action : -relaxation & dilatation of the cervix . -uterine muscle contraction . It potentiate the effect of oxytocic agent .

  • * following insertion of prostaglandin : 1- woman lies down for 30 minutes .2-attach with CTG .3-recommended dose PGE23mg tab. 4- assess after 6hrs .5- if no response another 3mg inserted in the posterior fornix of the vagina .6-maximum dose 6mg .PGE2gel 4mg .

  • * disadvantages : Nausea .Vomiting .Diarrhea.N.B :use of oxytocic agent after 6hrs of prostaglandin .

  • * PGE1 (misoprostol): - oral .-sublingual .-vaginal .-200mcg IOL.-more effective .-less expensive .-if used with oxytocic agent cause hyper stimulation .

  • -* risk of prostaglandinE2: - hypertonic uterus .-abruptioplacenta .-fetal hypoxia .-pulmonary ,amniotic fluid embolism .-rare uterine rupture .- c.s delivery .

  • @ AROM :-amniotomy .-used to induce labor if cervix is favorable & fixed presenting part .-do abdominal examination before .-vaginal examination .-bag of water lying in front of the presenting part ( fore water) ruptured by amniohook .-asses fluid for color ,volume .-

  • check FHR .-increase risk of chorioamniotis .-ascending infection of genital tract ,increase perinatal mortality rate .-establish of oxytocin after ROM .-PGE2produced from amnion & cervix ,during pregnancy chorine secret enzyme called PGDH(prostaglandins dehydregnase enzyme ) that break PGE2thus preterm labor is avoided .

  • @ oxytocin : -act on smooth muscle ,secreted from posterior pituitary gland .receptors of oxytocin found on myometrium.. - syntocinon is synthetic of oxytocin uterotonic agent . -used for IOL after AROM done .

  • I.V drip slowly .Put in normal saline .Monitor FHR ,& uterine condition .- observe for hypertonic uterine contraction .- monitor intensity ,duration ,frequency of uterine contraction .

  • .*risk of oxytocin: -hypertonic (hyper stimulation )- fetal hypoxia .-uterine rupture .-fluid retention .-post partum hemorrhage .-amniotic fluid embolism (AFE)

  • ********* midwifery role toward induction of labor :-proper antenatal care .-intrapartum care .-full explanation about induction .-fill part gram .-.

  • monitor side effect of each type .-abdominal examination & vaginal examination .- u\s .-give pain relieve

  • * alternative approach to initiate labor : 1-ingestion of caster oil .2-nipple stimulation .3-sexual intercourse .4-acupuncture .5-homeopathic method .