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Chapter-06 Prolonged Pregnancy

BOOK TITLE: Management of High-Risk Pregnancy—A Practical Approach

Author
1. Suneja Amita
2. Jain Sandhya
ISBN
9789380704739
DOI
10.5005/jp/books/11228_6
Edition
1/e
Publishing Year
2010
Pages
8
Author Affiliations
2. The University College of Medical Sciences (UCMS) and Guru Teg Bahadur (GTB) Hospital, New Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital,Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, sumeet_singla@indiatimes.com, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
Chapter keywords

Abstract

Prolonged pregnancy is defined as pregnancy beyond 42 completed weeks (294 days) calculating from the first day of last menstrual period. Risks associated with postterm pregnancy include increased chances of cephalopelvic disproportion, instrumental and operative delivery, macrosomia, birth asphyxia, meconium aspiration, bone fracture, peripheral nerve paralysis, stillbirth, and intrauterine death. The perinatal mortality rate (i.e. stillbirths plus neonatal deaths) approximately doubles by 42 weeks gestation and is four to six times greater at 44 weeks. The major causes of death include chemical pneumonitis due to meconium aspiration, prolonged labor with cephalopelvic disproportion, unexplained anoxia and malformations. There is increased maternal morbidity due to hazards of induction, instrumental and operative delivery First trimester ultrasound should be offered, ideally between 11 and 14 weeks to all women, as it is a more accurate assessment of gestational age than last menstrual period with fewer pregnancies prolonged past 41 + 0 weeks. Low-risk women should be offered induction of labor at 41 weeks. Antenatal testing used in the monitoring of the 41 to 42 week pregnancy should include biweekly nonstress test and an assessment of amniotic fluid volume. Good communication between the physician and patient, along with a discussion of the risks and benefits involved, is critical to ensure that informed decisions are made. Women should be offered the option of weekly membrane sweeping, commencing at 38–41 weeks, following a discussion of risks and benefits to prevent postterm birth.

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