PROLONGED PREGNANCY

Definitions
RISKS
Placental insufficiency and
Increased fetal wt, ossification of skull &
Post date pregnancy: continuation of
hypoxia
decreased moulding
pregnancy beyond 40 completed weeks
1. Increased perinatal
1. Prolonged labour and failure to progress:
Post term pregnancy: continuation of
mortality:
Doubled
for
increase incidence of C/S
pregnancy beyond 42 completed weeks
each week after 42 weeks 2. Shoulder dystocia:
Incidence
Maternal risks: vaginal & cervical lacerations
2.
Meconium aspiration
5-10% of pregnancies
& rupture uterus
syndrome
Aetiology
Neonatal risks:
3. Oligohydromnios
In majority of cases there is no
i.
Neonatal asphyxia & death
4. Cord compression
underlying cause (its a physiological
ii.
Cervical cord injury
continuation of pregnancy)
iii.
Brachial plexus injury: Phrenic N. injury
Extremely rare, due to
(C4 injury), Erbs palsy (C5&C6 injury),
i.
Anencephaly
Klumpks palsy (C8 & T1)
ii.
Fetal adrenal hypoplasia
iv.
Clavicular & humeral fractures
iii.
Placental sulphatase enzyme
deficiency
How to manage pt in Post-date & Post-term pregnancy
Assesment of GA:
Before delivery
During delivery
A.Antenatal methods
1. Counselling and explanation
Uncomplicated post-date
1. 1st day LMP (reliable in 50% of
Explain the risk of post-date and post
pregnancy)
pregnancy: deliver at
term on the fetus
2. U/S: CRL (7-13 weeks), BPD & FL (13-26
40+3-7 days
2. History
Method of delivery:
weeks & >26 weeks)
For accurate assessment of GA
a. Induction of labour
3.Clinical:
To exclude contraindications for
(depends on Bishop
i.
early pregnancy symptoms
induction
score)
ii.
early bimanual exam
3. Obs exam
b. C/S if theres
iii.
quickening
To assess lie, presentation and
iv.
serial fundal ht
contraindication for
engagement
induction
4. Vaginal exam
B.Postnatal methods
If delivery by induction of
To assess Bishop score and pelvic

adequacy
5. U/S (at 40, 41 and 42 weeks)
To assess amount of liquor, fetal
wellbeing and wt
6. CTG (every 3 days after 40 weeks)
To assess fetal wellbeing

labour, senior obs(risk of

shoulder dystocia) and
paed(risk of meconium
aspiration) should attend
the delivery.

1. Dubowit score: assessment of physical

and neurological features of the newborn
2. Farr score: assessment of physical
features of the newborn