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Chapter-28 Prolonged Pregnancy

BOOK TITLE: Essentials of Obstetrics

Author
1. Mathai Matthews
2. Subhasri B
ISBN
9788180613623
DOI
10.5005/jp/books/10288_28
Edition
1/e
Publishing Year
2004
Pages
5
Author Affiliations
1. Christian Medical College and Hospital, Vellore, India, Christian Medical College, Vellore, Christian Medical College and Hospital, Vellore
2. Christian Medical College and Hospital, Vellore, India
Chapter keywords
prolonged pregnancy, perinatal morbidity and mortality, ultrasound, placental function, failing placental perfusion, renal perfusion, oligohydramnios, reduced amniotic fluid volume, cord compression, fetal heart rate decelerations, fetal death, pre-induction ripening of the cervix, prostaglandins, cardiotocography, amnioinfusion, normal saline, meconium stained liquor, fetal heart rate patterns, partograph, fetal macrosomia, shoulder dystocia, gestational age, ultrasound scan, electronic fetal monitoring, fetal heart rate abnormalities, intermittent auscultation, meconium stained, oropharyngeal suction

Abstract

Prolonged pregnancy is a common clinical problem today. It is associated with significant increase in perinatal morbidity and mortality and is therefore a common indication for induction of labor. The routine use of ultrasound for confirmation of dates in early pregnancy reduces the number of inductions for suspected prolonged pregnancy. Placental function may fail in prolonged pregnancy. Failing placental perfusion may result in reduced renal perfusion and oligohydramnios. Reduced amniotic fluid volume and the resultant cord compression are associated with fetal heart rate decelerations. Late and prolonged decelerations and fetal death may also occur in some of these cases. Pre-induction ripening of the cervix with prostaglandins will increase the number of successful inductions. Cardiotocography and liquor volume estimation are perhaps the most commonly used methods for fetal assessment in prolonged pregnancy. Amnioinfusion with normal saline should be considered if there is meconium stained liquor in early labor and fetal heart rate patterns do not warrant immediate delivery. Monitor progress in labor using the partograph. Fetal macrosomia may be associated with poor progress in labor and shoulder dystocia. Where the gestational age is unsure, an ultrasound scan is done to estimate gestation. The progress of labor is monitored closely using a partograph. We use continuous electronic fetal monitoring if fetal heart rate abnormalities are noted on intermittent auscultation and when liquor is meconium stained. In the absence of fetal heart rate abnormalities that warrant immediate delivery, we use amnioinfusion whenever there is meconium stained liquor. We also carry out oropharyngeal suction as soon as the head is born.

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