Flashcards in Prolonged pregnancy Deck (6)
What is the definition of post term or prolonged pregnancy?
>/= 42 weeks
What proportion of women labour post term?
What are the risks of prolonged pregnancy?
Increased risks of:
- Neonatal death
- death within 1st year of life
Due to increased risk of:
- Meconium aspiration.
- Macrosomia and larger babies resulting in:
- Prolonged labour.
- Cephalo-pelvic disproportion.
- Shoulder dystocia.
- Birth injury resulting in, for example, brachial plexus damage or cerebral palsy.
- Neonatal acidaemia.
- Low five-minute Apgar scores.
- Neonatal encephalopathy.
- Neonatal seizures.
- Features of intrauterine growth restriction (IUGR) due to placental insufficiency
What is the evidence for timing of post dates induction?
Multicentre RCT published in BMJ in 2019 showed improved outcomes for perinatal morbidity and mortality when IOL at 41+0 versus expectant management until 42 weeks. 1.4% absolute risk reduction in perinatal adverse event. No different in maternal outcomes or risk of caesarean delivery.
What management and advice should be given to women at risk of post-term?
- RCOG and NICE guidelines recommend that women should be offered induction after 41 weeks between 41+0 and 42+0 weeks to avoid the risks of post-term pregnancy, primarily increased intrauterine fetal death.
- Prior to formal induction of labour, women should be offered vaginal examination with membrane sweeping.
- If women choose not to have induction, this decision should be respected and from 42 weeks of pregnancy there should be increased monitoring with at least twice‑weekly cardiotocography and ultrasound estimation of maximum amniotic pool depth.
- Studies have also looked at the outcomes when labour is induced between 37 and 41 weeks of pregnancy and it appears to also reduce perinatal mortality week on week without increasing risk of operative delivery.