[13] Prolonged Pregnancy

Question 1

What is prolonged pregnancy also known as?

Answer 1

Post-dates pregnancy or post-term pregnancy

Question 2

What is prolonged pregnancy?

Answer 2

Any pregnancy that progresses beyond 42 weeks gestation

Question 3

What is prolonged pregnancy associated with?

Answer 3

Feta, neonatal and maternal complications

Question 4

When do the risks associated with prolonged pregnancy increase?

Answer 4

Immediately after term and significantly after 41 weeks

Question 5

What can be used to improve outcomes of prolonged pregnancy?

Answer 5

Induce labour before or at 42 weeks

Question 6

What are the risk factors for prolonged pregnancy?

Answer 6

• Previous post-term pregnancy
• Primigravidity
• High maternal BMI
• Genetic factors
• Advanced maternal age

Question 7

What signs indicate post-maturity of the baby before it is born?

Answer 7

• Reduced fetal movement
• Reduced volume of amniotic fluid causing reduction in uterus size
• Meconium-stained amniotic fluid when membranes rupture

Question 8

What characteristic features may a prolonged pregnancy baby have on delivery?

Answer 8

• Dry, peeling and cracked skin particularly on hands and feet
• Absence of vernix caseosa and lanugo
• Loss of subcutaneous fat
• Meconium staining of skin

Question 9

What fetal problems is prolonged pregnancy associated with?

Answer 9

Increased morbidity and mortality

Question 10

At what stage can death occur associated with prolonged pregnancy?

Answer 10

• Stillbirth
• Neonatal death
• Death in first year of life

Question 11

What is thought to cause the increased fetal mortality associated with prolonged pregnancy?

Answer 11

• Utero-placental insufficiency
• Meconium aspiration
• Intrauterine infection

Question 12

What conditions does prolonged pregnancy increase the risk of?

Answer 12

• Meconium aspiration
• Macrosomia and larger babies
• Neonatal acidaemia
• Neonatal encephalopathy
• Neonatal seizures
• Features of IUGR

Question 13

What can macrosomia lead to as a result of prolonged pregnancy?

Answer 13

• Prolonged labour
• Cephalo-pelvic disproportion
• Shoulder dystocia
• Birth injury

Question 14

What birth injuries can occur as a result of prolonged pregnancy?

Answer 14

• Brachial plexus damage

- Cerebral palsy

Question 15

What are the maternal risks of prolonged pregnancy?

Answer 15

• Obstructed labour
• Perineal damage
• Instrumental delivery
• C-section
• Postpartum haemorrhage
• Infection

Question 16

What complications can occur if labour is induced for prolonged pregnancy before the cervix is in a favourable state?

Answer 16

• Need for c-section
• Prolonged labour
• Post-partum haemorrhage
• Traumatic delivery

Question 17

When should women be offered induction for prolonged pregnancy?

Answer 17

After 41 weeks

Question 18

What does induction before 42 weeks do to prognosis of prolonged pregnancy?

Answer 18

• Fewer perinatal deaths

- Fewer c-sections

Question 19

What should women be offered before induction of labour?

Answer 19

Vaginal examination and membrane sweep

Question 20

What monitoring should women receive if they refuse induction after 42 weeks?

Answer 20

• Twice weekly cardiotocography

- USS estimation of maximum amniotic pool depth

Question 21

Why is induction of labour often difficult in prolonged pregnancy?

Answer 21

The cervix is often unfavourable

Question 22

What Bishop’s score is normally seen in prolonged pregnancy?

Answer 22

< 3

Question 23

What should be attempted to make the cervix more favourable for induction in prolonged pregnancy?

Answer 23

Prostaglandins and mechanical methods of cervical preparation

Question 24

When may c-section be the preferred method of delivery for prolonged pregnancy?

Answer 24

• Cervical preparation fails

- Infant is large

Question 25

Why is careful observation required in labour of prolonged pregnancy?

Answer 25

They are high risk pregnancies