Postterm Pregnancy

Front 1

Foley bulb or balloon catheter

Back 1

•Mechanical device used to stretch the cervix: 16 guage Foley catheter is inserted into cervical canal and balloon is dilated to 25-50m ililiters
•Relatively safe, easy to place and remove, does not require fetal monitoring as with hormonal methods
•Similar effects with laminaria and synthetic osmotic dilators
•Clinical trials not sufficient to make specific recommendations

Front 2

Mechanical methods include laminaria and synthetic osmotic dilators

Back 2

•Mechanical stimulation of the cervix has been shown to trigger endogenous prostaglandin synthesis and release which reduces cervical stiffness and helps in cervical ripening and labor induction
•The release of oxytocin may play a role in cervical ripening

Front 3

Membrane Stripping:

Back 3

• Onset of contractions = within 72 hours. (Varney p728)
•Mechanism of action: release of prostaglandins into the maternal bloodstream.
•Reduces the gestational period by 2 to 5 days, reducing postdate pregnancies
•Method is validated by research, although some conflicting results in terms of effectiveness
Reduces need for formal methods of labor induction
No evidence that sweeping membranes increases the risk of maternal and neonatal infection or of PROM
Women may experience discomfort during the procedure, bleeding and irregular contractions
Risks may include infection, bleeding, and accidental ROM

Front 4

AROM

Back 4

•Should only be done with commitment to the birth
•Increased infections, uterine hyperstimulation, and fetal distress with earlier amniomity (2cm dilation) vs later (5cm dilation)
•No well designed studies that have evaluated this practice even though it is frequently used
•Should not be used alone to induce labor

Front 5

Castor Oil

Back 5

•Mechanism poorly understood, thought to stimulate prostaglandin synthesis
•Increases the contractile work of the uterus by 186%
•Oral ingestion of 60mg Castor oil stimulates the gut which stimulates the vagal nerve, stimulating the uterus
•Absorption of fluid and electrolytes is reduced in the small intestine, stimulating peristalsis
•Onset is within 2-6 hours- best given after a good night’s sleep (1-2 hrs before woman usually rises) to a woman at term

Front 6

Homeopathy

Back 6

Caulophyllum 30

Front 7

Bishop's score

Back 7

1)Dilation (cm)
2)Effacement (%)
3)Station
4)Consistency
5)Position
*elective inductions were more successful and safe with a score of 9 or more

Front 8

Postterm management

Back 8

Diagnostic:
1)Review of dating criteria
2)Leopolds for EFW.
3)Examine cervix. Bishop score >5 is favorable.
4)Consider U/S to R/O congenital anomaly.
Therapeutic:
1)Consider sweeping membranes at 38-41 weeks. Discuss with client.
2)See alternative methods of induction.
3)Patients with high risk factors, such as GDM or HTN, should not be allowed to progress beyond 42 weeks.
Education:
1)Offer induction at 42 weeks or expectant management.
2)Postdates management (tests, induction methods, risks and benefits)
3)Encourage sexual intercourse.
Follow up:
1)Biweekly antenatal testing should be initiated at 41 weeks. This should include an NST and an AFI (modified BPP).
2)Kick counts should be initiated at 40-41 weeks.
ACOG recommends induction at 41 weeks

Front 9

Definition postterm pregnancy

Back 9

After 42 weeks gestation