Prolonged pregnancy Prolonged pregnancy Post term pregnancy = prolonged pregnancy Post term pregnancy = prolonged pregnancy - post maturity : describe

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<ul><li><p>Prolonged pregnancyPost term pregnancy = prolonged pregnancy - post maturity : describe neonate that have specific characteristics as long nails ,loose skin ,peeling of epidermis .</p></li><li><p>Prolonged pregnancy increase risk of perinatal morbidity &amp; mortality rate .*definition of prolonged pregnancy : as pregnancy equal to or more than 42 weeks or 294 days from the 1st day of LMP .</p></li><li><p>* 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</p></li><li><p>@fetus : 1- bone injury .2-soft tissue trauma .3-hypoxia .4-cerebral hemorrhage .5-still birth . </p></li><li><p>@neonate : 1- SGA ( small gestational age ) 2- me conium aspiration .3-asphyxia .</p></li><li><p>Goal : reach optimum outcome for mother &amp; baby .</p><p>Predisposing factors of prolonged pregnancy :</p></li><li><p>@previous prolonged pregnancy .@male fetus . @ null parity @body mass index of pregnancy more than 25Kg\M@anencephaly .</p></li><li><p>management of prolonged pregnancy consent form need to take by mother &amp; her husband to do induction of labor .To assess fetal being do : NST :non stress test &amp; u\s to estimate AFV by using amniotic fluid index AFI </p></li><li><p>CTG .-Monitor FHR with two acceleration of more than 15 seconds ,above base line in 20 minutes .Any irregularities mean non reassuring CTG .</p></li><li><p>* membrane sweep : -Done at 41 weeks gestation , Increase onset of spontaneous labor physiologically, to avoid use of prostaglandin ,AROM ,&amp; oxytocin .</p></li><li><p>* procedure :- introducing the examining fingers into cervical os &amp; 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</p></li><li><p>induction of labor : IOL </p><p>*Done at 41 weeks gestation .Used to uncomplicated pregnancy .Could be done at 42weeks gestation .Full assessment should be done .</p></li><li><p>* indications of IOL : 1- PIH .2- GDM.3-IUGR.4-macrosomia .5-social reason</p></li><li><p>@ maternal indications :* prolonged pregnancy .*HTN,PIH,according to mother symptoms .*DM ,still birth ,macrosomia .*prelabor ROM after 24hours of ROM .*maternal request ,psychological &amp; social reason</p></li><li><p>.@fetal indications :*IUGR less than 34weeks .*macrosomia,decrease incidence of shoulder dystocia .*fetal death .*fetal anomaly .</p></li><li><p>@ contraindication of IOL ;* placenta previa .*transverse lie ( compound presentation .*HIV positive woman .* active genital herpes .*cord presentation &amp; cord prolapse .*known case of CPD *severe acute fetal compromise. </p></li><li><p>@ method of induction :-favorable cervix ( dilated &amp; 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 .</p></li><li><p>@ 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 .</p></li><li><p>@ prostaglandin E2( pGE2) dinoprostone :-PGE2&amp; PGF2 normally produced by cervix ,uterus ,deciduas ,&amp;fetal membrane .-act locally on these structure .-PGE2 vaginal tab. ,gel ,pessaries .-</p></li><li><p>placed in the posterior fornix of the vagina .-it absorbed by epithelium of the vagina &amp; cervix .Action : -relaxation &amp; dilatation of the cervix . -uterine muscle contraction . It potentiate the effect of oxytocic agent .</p></li><li><p>* 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 .</p></li><li><p>* disadvantages : Nausea .Vomiting .Diarrhea.N.B :use of oxytocic agent after 6hrs of prostaglandin .</p></li><li><p>* PGE1 (misoprostol): - oral .-sublingual .-vaginal .-200mcg IOL.-more effective .-less expensive .-if used with oxytocic agent cause hyper stimulation .</p></li><li><p>-* risk of prostaglandinE2: - hypertonic uterus .-abruptioplacenta .-fetal hypoxia .-pulmonary ,amniotic fluid embolism .-rare uterine rupture .- c.s delivery .</p></li><li><p>@ AROM :-amniotomy .-used to induce labor if cervix is favorable &amp; 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 .-</p></li><li><p>check FHR .-increase risk of chorioamniotis .-ascending infection of genital tract ,increase perinatal mortality rate .-establish of oxytocin after ROM .-PGE2produced from amnion &amp; cervix ,during pregnancy chorine secret enzyme called PGDH(prostaglandins dehydregnase enzyme ) that break PGE2thus preterm labor is avoided .</p></li><li><p>@ 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 .</p></li><li><p>I.V drip slowly .Put in normal saline .Monitor FHR ,&amp; uterine condition .- observe for hypertonic uterine contraction .- monitor intensity ,duration ,frequency of uterine contraction .</p></li><li><p> .*risk of oxytocin: -hypertonic (hyper stimulation )- fetal hypoxia .-uterine rupture .-fluid retention .-post partum hemorrhage .-amniotic fluid embolism (AFE)</p></li><li><p>********* midwifery role toward induction of labor :-proper antenatal care .-intrapartum care .-full explanation about induction .-fill part gram .-.</p></li><li><p>monitor side effect of each type .-abdominal examination &amp; vaginal examination .- u\s .-give pain relieve</p></li><li><p>* alternative approach to initiate labor : 1-ingestion of caster oil .2-nipple stimulation .3-sexual intercourse .4-acupuncture .5-homeopathic method .</p></li></ul>