Prolonged pregnancy

Question 1

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy. Discuss management of this patient.

Answer 1

History
Examination
Investigations
Problem list
Associated risks
Management
Side effects of misoprostol
Alternate IOL methods
Poor progression management
Instrumental delivery requirements
Advice for future pregnancies

Question 2

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

History

Answer 2

HIV tested last
Obs hx
Fetal movements
Rest of history

Question 3

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Examination

Answer 3

BP 150/95
Pallor
Rest of exam

Question 4

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Investigations

Answer 4

Repeat HIV 
Urine dipstick
Sonar
CTG
Hb
PET bloods

Question 5

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Problem list

Answer 5

1. Primigravida
2. Post-term pregnancy
3. Anemia
4. Hypertension

Question 6

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Risks assoc with post term pregnancy

Answer 6

Maternal - psych stress
Fetal
- SB
- MSL
- MAS
- decr cord pH
- shoulder dystocia

Question 7

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Management of problem list

Answer 7

1. Admit to labour ward
2. Short acting antiHT
3. IOL depending on Bishop score
   - 25ug every 2hrs po x 12 doses max 72hrs
   - CTG before and after each dose
   - stop once contractions established

Question 8

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Side effects of misoprostol

Answer 8

Uterine rupture
Nausea
Vomiting
Headache
Dizziness 
Fever

Question 9

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Bishop score?

Answer 9

Dilation
Length
Consistency
Position
Station

Question 10

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Alternate IOL methods

Answer 10

Mechanical induction
PE2
Oxytocin and AROM

Question 11

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Assess and manage poor progression of labour

Answer 11

Patient
- psych
- pain
- hydration
- bladder
- position
Power
- need 3-4 contractions/10min >30s -> otherwise give oxytocin infusion
Passenger
- fetal size, lie, presentation, position, HR, HAB
Passage
- cervix, membranes, application, presenting part, pelvic size and shape

Question 12

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Requirements for an instrumental delivery

Answer 12

Consent
Analgesia
Vertex
Full cervical dilation
No HAB
No CPD
Ruptured membranes
Experienced operator
Functional equipment

Question 13

Ms TN a 23yo P0G1 at 41w GA by sure dates to ANC. Booked with normal bloods and uneventful pregnancy.

Advice for future pregnancies

Answer 13

Breastfeeding
Contraception options
Family spacing