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23 Cards in this Set
- Front
- Back
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Post term/prolonged pregnancy |
A pregnancy that lasts beyond 42 completed weeks starting from the first date of the last menstrual period |
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Post date pregnancy |
Pregnancy that has lasted beyond 40 weeks from the first date of the last menstrual period but has not gotten up to 42 weeks |
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Incidence of prolonged pregnancy |
2-19% of pregnancies |
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Etiological factors |
Unknown. However some researchers have implicated some factors viz:-•Wrong dates: Irregular periods, hormonal contraceptives, breast feeding, unsure date•Hereditary•Previous hx of prolonged pregnancy•Inaccurate estimation of EDD.•Obesity•Primigravidity•Male gender foetus•Fetal anencephaly•Placental sulfatase deficiency (estriol) |
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Fetal risks of prolonged pregnancy |
~Stillbirths/ Perinatal mortality ~Meconium aspiration ~Neonatal acidaemia ~Macrosomia ~Birth trauma (Dystocia etc) ~Hypoglycemia ~Seizure disorders ~Cerebral palsy. ~Post maturity syndrome (fetal skin changes, overgrown nails, minimal subcutanous fat; a lot of hairs on the baby’s head etc).
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Maternal risks of prolonged pregnancy |
~Anxiety~Increased risk of c/s~Labour dystocia~Perineal Injury~Operative vaginal delivery~Thrombo-embolic disorders ~Chorioaminionitis~Endometritis,2ndry P.P.H.~ Death of the mother. |
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Management of prolonged pregnancy |
History to verify date, fetal kick. Physical Exam:- SFH may be reduced. Investigations:- PCV, Urinalysis, Blood grouping & cross matching of 2 units, USS for BPP especially liquor volume. Treatment:- If no spontaneous labour by 40wks + 10days, prompt delivery is necessary either through induction of labour or c/s. The route of delivery depends on the outcome of the review (severe oligohydramnios or poor BPP may benefit from C/S). |
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Prevention of prolonged pregnancy |
Encourage early booking and 1st trimester USS dating Membrane sweep at term. Unprotected sexual intercourse Elective I0L or c/s before 42 wks G.A.
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Induction of labour |
The artificial initiation of labour in a pregnant woman after 28 weeks of gestation with intact fetal membranes with the aim of achieving spontaneous vaginal delivery |
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Indications |
Fetal: •prolonged pregnancy •rhesus iso-immunization •IUFD •IUFR •unstable lie •fetal abnormality •chorioamnionitis Maternal: •pre-eclampsia •eclampsia •PROM •polyhydramnios •D.M •renal diseases •chronic hypertension •sickle cell disease •precipitate labour •social reasons: pt's convinience |
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Contraindications to IOL |
•Contracted pelvis •cord presentation •previous classical c/s, 2 or more previous lower segment c/s •placenta praevia •Grand multiparty •invasive cancer of the cervix •vasa praevia •Malpresentation - footling breech, transverse lie •extensive myomectomy
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PREPARATION FOR INDUCTION |
•Counsel the pt and get a consent.•Confirm the G.A (LMP or early uss)•Confirm adequate pelvis and r/o C/I for V.D•Is the hospital capable of managing complications.•Group & cross match 2 units of blood.•Inform the theater•Do Bishop’s score to know if the cervix is ripe or not |
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Bishop's scoring system |
Maximum Score is 13 Scores 5 or less are unfavourable (unripe) Scores 6 and above are favourable (Ripe) If the cervix is unripe, it has to be ripened by artificial means before commencement of induction. |
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Methods of cervical ripening |
A. PHARMACOLOGICAL METHODS •Prostaglandin analogues e.g Misoprostol (PgE1 Analogue). Insert 25μg or 50μg 4-6 hourly. •Low concentrated oxytocin drip. •Prostaglandin E2 Pessary at the posterior fornix •Relaxin gel •Estradiol valerate gel B. MECHANICAL METHODS •Membrane sweep •Intracervical extra amniotic foley’s catheter (20,22) inflated with 30-50ml of N/S or sterile water. •Lamineria tents/ Digitata •Dilapan •Nipple stimulation |
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Methods of Induction of labour |
This can be surgical or medical 1. SURGICAL •ARM:- This involves rupturing the membranes artificially. It can lead to cord prolapse. Check the F.H.R before and after the ARM. •Synchronous use of ARM and oxytocin. Usually about 2 hours apart. •Extra amniotic saline infusion. 2. MEDICAL: Oxytocin titration:- 5iu in 500ml of fluid (N/S, D/W, Ringer’s) starting with 10dpm and increasing by 10dpm after every 30 mins. Or 45 mins in grand multips. until adequate contraction is achieved (3 in 10mins lasting for 45secs). If up to 60 drops/min is reached without adequate contraction, reconstitute another drip of 10iu in 500ml and start from 30dpm and increase accordingly. Give a gap of at least 6 hours after the last misoprostol because sometimes the misoprostol will initiate labour without requiring oxytocin drip. This is to avoid uterine rupture. It is very important to monitor the mother and foetus closely during induction of labour. |
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Complications of induction of labour |
•Failed induction •uterine rupture •fetal distress •hyperstimulation •PPH •precipitate labour •IUFD •water intoxication •NNJ, Prematurity •amniotic fluid embolism •cord prolapse. |
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Failed induction |
Any reason that makes it impossible for achieving a vaginal delivery during the process of induction of labour e.g •Inability to achieve adequate uterine contraction despite optimal use of oxytocin •Foetal or maternal distress •Cord prolapse •CPD e.t.c MGT: Emergency C/S |
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Augmentation of labour |
This implies that labour has already started but not progressing well due to poor uterine contractions. Therefore the labour is helped to progress further. It is important to make sure that the poor progress is not due to CPD or malpresentation/malposition. NB:- Augmentation is helpful if the poor progress is due to poor contractions only. The procedure of oxytocin titration is same as in induction of labour. |
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Complications of artificial rupture of membranes |
The most common complication of amniotomy is cord prolapse, which usually occurs during the sudden and rapid egress of amniotic fluid. Rupture of a vasa previa during amniotomy can cause life-threatening fetal blood loss. Both of these complications require emergency cesarean delivery.An increased incidence of chorioamnionitis is seen, especially with prolonged rupture of membranes. Cord compression associated with variable decelerations of the fetal heart rate occurs more often after amniotomy. Minor fetal scalp trauma may also occur, especially if the fetal head is closely applied to the membranes when amniotomy is performed |
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Reasons for artificial rupture of membranes |
The reasons for the intentional rupture of the amniotic sac during labor are multifold and include, but are not limited to, influencing the speed of labor, allowing for more direct monitoring of fetal status, and qualitative assessment of the amniotic fluid. The two principal reasons for artificial rupture of membranes are (1) to induce or augment the labor process or (2) to assist in placement of internal fetal monitoring to provide the direct assessment of fetal status. |
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The membrane of amniotic cavity is made up of how many layers |
The amniotic cavity is comprised of a dual layer membrane, which includes an inner layer known as the amnion and an outer layer known as the chorion. |
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Equipment for the procedure of ARM |
•Amniotomy hook or amniotomy finger cot •Sterile gloves and lubricant. •Personal protective equipment (gloves, gown, drapes, mask, eye protection) •Absorbent pads and towels to be placed under the patient •Electronic fetal monitor (Cardiotocography CTG) •Tocolytics should be available |
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Contraindications to artificial rupture of membranes |
Artificial rupture of membranes should not be undertaken in the case of malpresentation, vasa previa, Suspected velamentous insertion of the umbilical cord or in case of the unengaged fetal head or unstable lie. If the fetal Presentation is unknown or not fully engaged as the risk for cord prolapse is increased. If the pregnant woman is not in active labor or if the patient refuses the intervention. |
