MANAGEMENT OF

PROLONGED
PREGNANCIES

SITI NUR BAITI BINTI SHAIK

KHAMARUDIN
012013100196
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OUTLINE
How to manage?
Antepartum management
Prognostic factors of successful induction
Overall management recommendation

Intrapartum management
Reference

HOW TO MANAGE?
The decision centers on whether:
Labor induction, or
Expectant management with fetal surveillance
(waiting)

Routinely induce women at 41 weeks.

Fetal testing until 42 weeks performed
twice weekly.
Nonstress test

AFI

ANTEPARTUM MANAGEMENT

(A) UNFAVOURABLE CERVIX

Bishop score < 7 in 80%
Women with no cervical dilatation have
twofold increased cesarean delivery rate for
dystocia.
Cervical length 3cm is predictive of
successful induction.

(B) CERVICAL RIPENING

PGE2 Dinoprostone
vaginal tablet

FOLEY CATHETER

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EXTRA AMNIOTIC SALINE

INFUSIONS

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LAMINARIA TENT

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SWEEPING AND STRETCHING

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(C) STATION OF VERTEX

Studies done in 2004 on 484 nulliparas
who underwent induction after 41 weeks.
Cesarean delivery rate was directly
related to station:
6% at -1
20% at -2
43% at -3
77% at -4
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MANAGEMENT
RECOMMENDATION
Not mandatory but

initiation of fetal
surveillance at 41 weeks
is reasonable.
After completing 42

weeks, either antenatal

testing or labor induction
is recommended.
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 Consider 41-week pregnancies without

complications.
If there are complications e.g. : Labor
a) Hypertension
b) Decreased fetal movement, or
c) Oligohydramnios

should
be
induced

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WOMEN OF
CERTAIN
GESTATIONAL
AGE
Labor is induced at week
42
90% are induced
successfully or enter labor
within 2 days of induction
If not deliver:
2nd induction within
3 days
Unusual 3rd
induction
Induction vs LSCS

WOMEN OF
UNCERTAIN
GESTATIONAL
AGE
Weekly nonstress fetal
testing & assessment
of amniotic fluid
AFI 5 cm or reports
of diminished FM
should undergo labor
induction
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INTRAPARTUM
MANAGEMENT

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THICK MECONIUM IN AMNIOTIC

FLUID
The viscosity probably signifies lack of fluid
oligohydramnios
Why we dont aspirate for assessment?
May cause severe pulmonary dysfunction and
neonatal death

Hence, amnioinfusion is done during labor

A way of diluting meconium to
syndrome.

aspiration

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Amnioinfusion

FHR and uterine resting

tone are assessed
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IMPORTANCE
Successful SVD is reduced in
nulliparous woman who is in early labor
with thick meconium-stained amniotic
fluid.
Hence if she is remote from delivery,
prompt LSCS is considered especially if:
Cephalo-pelvic disproportion
Hypotonic or hypertonic dysfunctional labor
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REFERENCE
Obstetrics Today 2nd Edition
Williams Obstetrics 24th Edition
http://bmc1.utm.utoronto.ca/~amanda/visua
ltoolssite/postdates_basics.html

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