Prolonged Pregnancy and Induction of Labour

Question 1

What is the definition of prolonged pregnancy?

Answer 1

Pregnancy lasting beyond 42 completed weeks (≥294 days from LMP).

Question 2

What is the difference between post-date and post-term pregnancy?

Answer 2

Post-date: >40 weeks; Post-term: >42 weeks.

Question 3

What is the incidence of prolonged pregnancy?

Answer 3

4–14% of all pregnancies.

Question 4

What is the most common cause of prolonged pregnancy?

Answer 4

Wrong dating.

Question 5

Name two biochemical causes of prolonged pregnancy.

Answer 5

X-linked placental sulfatase deficiency, anencephaly.

Question 6

List risk factors for prolonged pregnancy.

Answer 6

Primigravida, previous prolonged pregnancy, maternal obesity.

Question 7

List maternal complications of prolonged pregnancy.

Answer 7

Obstructed labour, shoulder dystocia, severe genital injuries, CS, endometritis, haemorrhage, thromboembolism, emotional distress.

Question 8

List foetal complications of prolonged pregnancy.

Answer 8

Perinatal mortality, foetal distress (e.g., from oligohydramnios), MAS, post maturity syndrome, birth trauma.

Question 9

What is Meconium Aspiration Syndrome?

Answer 9

Aspiration of thick meconium by the newborn; leads to respiratory complications.

Question 10

What is Post Maturity Syndrome?

Answer 10

Syndrome seen in 20% of foetuses at 42 weeks with features of foetal compromise.

Question 11

What are features of Post Maturity Syndrome?

Answer 11

Wrinkled skin, decreased fat, green/yellow staining, fragile foetus, acidosis, risk of neonatal encephalopathy.

Question 12

What are the two approaches to management of prolonged pregnancy?

Answer 12

Expectant vs Active management.

Question 13

What are the benefits of active management in prolonged pregnancy?

Answer 13

Reduces perinatal mortality and CS rate.

Question 14

What is expectant management in prolonged pregnancy?

Answer 14

Monitoring pregnancy >40 weeks with foetal surveillance until spontaneous labour or indication for delivery.

Question 15

When should antepartum foetal surveillance begin in post-date pregnancy?

Answer 15

At 41 weeks.

Question 16

What methods are used in antepartum foetal surveillance?

Answer 16

Foetal kick chart, non-stress test, contraction stress test, biophysical profile, amniotic fluid volume, Doppler U/S.

Question 17

What is the definition of induction of labour?

Answer 17

Artificial initiation of contractions to achieve vaginal delivery before spontaneous labour.

Question 18

What is the incidence of IOL?

Answer 18

3–20%.

Question 19

What is the most common indication for IOL?

Answer 19

Prolonged pregnancy.

Question 20

List maternal indications for IOL.

Answer 20

Diabetes, hypertension, renal disease, SLE.

Question 21

List pregnancy-related indications for IOL.

Answer 21

Pre-eclampsia, intrahepatic cholestasis, abruption with IUFD.

Question 22

List foetal indications for IOL.

Answer 22

IUGR, oligohydramnios, Rh isoimmunisation, IUFD.

Question 23

List maternal contraindications to IOL.

Answer 23

Contracted pelvis, ≥2 C-sections, classical scar, uterine surgery, previous VVF repair, pelvic tumour.

Question 24

List foetal contraindications to IOL.

Answer 24

Persistent abnormal lie, placenta praevia, brow or mento-posterior face presentation.

Question 25

What are the steps in preparation for IOL?

Answer 25

Review indication, date confirmation, informed consent, maternal/foetal exam, lab work, paediatrician alert.

Question 26

What is cervical ripening?

Answer 26

Preparation of the cervix to facilitate dilation before or during labour.

Question 27

What Bishop Score indicates a ripe cervix?

Answer 27

Bishop Score ≥7.

Question 28

List pharmacologic methods of cervical ripening.

Answer 28

Misoprostol (PGE1), Dinoprostone (PGE2).

Question 29

List non-pharmacologic methods of cervical ripening.

Answer 29

Membrane sweeping, Foley’s catheter, Laminaria tents.

Question 30

What are the main agents used in IOL?

Answer 30

Oxytocin and prostaglandins.

Question 31

What is the role of prostaglandins in IOL?

Answer 31

Stimulate contractions and ripen cervix.

Question 32

Describe the mechanism of action of oxytocin.

Answer 32

Released by posterior pituitary; stimulates uterine smooth muscle and has antidiuretic effects.

Question 33

How is oxytocin infusion typically administered?

Answer 33

5 IU in 500 mL or 10 IU in 1000 mL; start at 1–2 mIU/min, increase every 20–30 mins to max 16–32 mIU/min.

Question 34

What is the goal for uterine contractions during IOL?

Answer 34

4 contractions in 10 minutes.

Question 35

How is foetal monitoring done during IOL?

Answer 35

Cardiotocography (CTG), partograph, intermittent auscultation.

Question 36

What is the most common complication of IOL?

Answer 36

Failed induction.

Question 37

List complications of induction of labour.

Answer 37

Intrapartum bleeding, vasa praevia rupture, uterine rupture, fetal distress, cord prolapse, sepsis, trauma, PPH.

Question 38

What is water intoxication and how is it related to IOL?

Answer 38

Excessive fluid from oxytocin infusions causing electrolyte imbalance.

Question 39

What is the overall goal of IOL?

Answer 39

• 39. Achieve safe delivery with best maternal and neonatal outcome.